PrepU Ch 40: Management of Patients with Gastric and Duodenal Disorders

The nurse is providing preoperative care for a client with gastric cancer who is having a resection. What is the nursing management priority for this client?

Correcting nutritional deficits

Which medication classification represents a proton (gastric acid) pump inhibitor?

Omeprazole

A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply.

- Famotidine - Nizatidine - Cimetidine

A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety? Select all that apply.

- Help identify the client's current stressors. - Interact with the client in a relaxed manner. - Discuss potential coping techniques with the client. - Offer information about relaxation methods.

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.

- Hemorrhage - Penetration - Perforation - Pyloric obstruction

A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply.

- Liver - Pancreas - Duodenum

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?

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

A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make?

"It aids in the healing of the stomach lining."

As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene?

Evaluate the client's understanding of the procedure.

Which medication is classified as a histamine-2 receptor antagonist?

Famotidine

The nurse is assessing a client with an ulcer for signs and symptoms of hemorrhage. The nurse interprets which condition as a sign/symptom of possible hemorrhage?

Hematemesis

A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client?

"Be sure to wear sunscreen while taking this medicine."

A client comes to the clinic reporting pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the client has a peptic ulcer?

"Does your pain resolve when you have something to eat?"

A client being treated for a peptic ulcer seeks medical attention for vomiting blood. Which statement indicates to the nurse the reason for the client developing hematemesis?

"The pain stopped so I stopped taking the medications."

The nurse is caring for a client with hypovolemia related to prolonged vomiting and decreased intake of oral fluids. What activity(ies) should the nurse include in the client's plan of care? Select all that apply.

- Administer intravenous fluids as ordered. - Advise the client to avoid alcohol

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.

- Checking the blood pressure and pulse rate every 15 to 20 minutes - Frequently monitoring hemoglobin and hematocrit levels - Observing stools and vomitus for color, consistency, and volume

A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems?

Acute gastritis

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following?

Mental confusion

Which of the following is considered an early symptom of gastric cancer?

Pain relieved by antacids

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition?

Peptic ulcers

The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience

pain 2 to 3 hours after a meal.

A client recovering from surgery to resect a gastric tumor reports abdominal cramping and diarrhea after eating. Which additional symptoms will the nurse use to determine if the client is experiencing dumping syndrome? Select all that apply.

- Report of extreme hunger 3 hours after eating - Sudden onset of extreme shakiness and fatigue

A client with gastric ulcers caused by H. pylori is prescribed metronidazole. Which client statement indicates to the nurse that teaching about this medication was effective?

"It might cause a metallic taste in my mouth."

A nurse is caring for a client who has had extensive abdominal surgery and is in critical condition. The nurse notes that the complete blood count shows an 8 G/dL hemoglobin and a 30% hematocrit. Dextrose 5% in half-normal saline solution is infusing through a triple lumen central catheter at 125 mL/hr. The physician orders include the following: Gentamicin 80 mg IV piggyback in 50 mL D5W over 30 minutes Zantac 50 mg IV piggyback in 50 mL D5W over 30 minutes One unit of 250 mL of PRBCs (packed red blood cells) over 3 hours Flush the nasogastric tube with 30 mL normal saline every 2 hours. How many milliliters should the nurse record as the intake for the 8-hour shift? Enter the correct number ONLY.

1470 mL

The nurse is caring for a client who has undergone a total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has minimal drainage. How should the nurse respond?

Document the findings.

During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take?

Notify the primary health care provider.

Peptic ulcer disease occurs more frequently in people with which blood type?

O

A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen?

10 to 14 days

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed?

Hemorrhage

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake?

Six small meals daily with 120 mL fluid between meals

A client diagnosed with gastritis is asking the nurse why famotidine is being prescribed instead of cimetidine, which they have been prescribed in the past. Which statement by the nurse is appropriate for this client?

"It has fewer drug to drug interactions."

Which of the following is the most successful treatment for gastric cancer?

Removal of the tumor

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse?

Assess the client's abdomen and vital signs.

A client with peptic ulcer disease has a blood pressure of 88/40 mm Hg, dizziness, and nausea. Which complication will the nurse suspect is occurring with this client?

Bleeding from the ulcer

Which of the following clients is at highest risk for peptic ulcer disease?

Client with blood type O

Clients with Type O blood are at higher risk for which of the following GI disorders?

Duodenal ulcers

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist?

Endoscopy

A client with gastric cancer is planning to receive chemotherapy. Which medication will be used as the primary agent to improve the tumor response rate?

Fluorouracil