PrepU Chapter 46: Gastric and Duodenal Disorders

Review the following four examples of ideal body weight (IBW), actual weight, and body mass index (BMI). Using three criteria for each example, select the body weight that indicates morbid obesity. IBW = 132 lbs; weight = 184 lbs; BMI = 28 kg/m2 IBW = 150 lbs; weight = 190 lbs; BMI = 26 kg/m2 IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 IBW = 175 lbs; weight = 265 lbs; BMI = 29 kg/m2

IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 Rationale: The criteria for morbid obesity are a body weight that is twice IBW and a BMI that exceeds 30 kg/m2.

Which medication classification represents a proton (gastric acid) pump inhibitor? a. Famotidine b. Omeprazole c. Metronidazole d. Sucralfate

b. Omeprazole Rationale: Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Metronidazole is an antibiotic, specifically an amebicide.

A nursing student is caring for a client with gastritis. Which of the following would the student recognize as a common cause of gastritis? Choose all that apply. a. DASH diet b. Overuse of aspirin c. Irritating foods d. Ingestion of strong acids e. Participation in highly competitive sports

b. Overuse of aspirin c. Irritating foods d. Ingestion of strong acids Rationale: Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. A DASH diet is an acronym for Dietary Approaches to Stop Hypertension, which would not cause gastritis. Participation in competitive sports also would not cause gastritis.

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

b. Severe peptic ulcers c. Gastrin-secreting tumors of the pancreas e. Extreme gastric hyperacidity Rationale: ZES consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. Diarrhea and steatorrhea may be evident. The client may have co-existing parathyroid adenomas or hyperplasia and may therefore exhibit signs of hypercalcemia.

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? a. Three meals and 120 ml fluid daily b. Six small meals daily with 120 mL fluid between meals c. Six small meals and 120 mL fluid daily d. Three meals and three snacks and 120 mL fluid daily

b. Six small meals daily with 120 mL fluid between meals Rationale: After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: a. drink liquids only with meals. b. drink liquids only between meals. c. restrict fluid intake to 1 qt (1,000 ml)/day. e. don't drink liquids 2 hours before meals.

b. drink liquids only between meals. Rationale: A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? a. Stool antigen test b. Barium study of the upper gastrointestinal tract c. Endoscopy d. Gastric secretion study

c. Endoscopy Rationale: Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. Less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test.

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? a. Bradypnea b. Bradycardia c. Mental confusion d. Hypertension

c. Mental confusion Rationale: Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.

A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? a. 4 to 6 days b. 15 to 20 days c. 7 to 9 days d. 10 to 14 days

d. 10 to 14 days Rationale: Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts (Pepto-Bismol).

The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following? a. Esophagus b. Pylorus c. Duodenum d. Stomach

c. Duodenum Rationale: Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.

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

d. Nasogastric tube insertion Rationale: The nurse anticipates an order for nasogastric tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.) a. "Is it possible that you are overusing aspirin." b. "It is probably your nerves." c. "It is a hereditary disease." d. "You may have ingested some irritating foods." e. "It can be caused by ingestion of strong acids."

a. "Is it possible that you are overusing aspirin." d. "You may have ingested some irritating foods." e. "It can be caused by ingestion of strong acids." Rationale: Acute gastritis is often caused by dietary indiscretion—the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.

A 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. a. Duodenum b. Liver c. Lungs d. Bladder e. Pancreas

a. Duodenum b. Liver e. Pancreas Rationale: Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.

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

a. Hematemesis Rationale: The nurse interprets hematemesis as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.

The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? a. Vomiting b. Hemorrhage c. Awakening in pain d. Constipation

c. Awakening in pain Rationale: The client with a duodenal ulcer is more likely to awaken with pain during the night than is the client with a gastric ulcer. Vomiting, constipation, diarrhea, and bleeding are symptoms common to both gastric and duodenal ulcers.

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. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. b. A sectioned portion of the stomach is joined to the jejunum. c. The antral portion of the stomach is removed and a vagotomy is performed. d. The vagus nerve is cut and gastric drainage is established.

a. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. Rationale: A Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum. A vagotomy severs the vagus nerve; a Billroth I procedure may be performed in conjunction with a vagotomy. If the remaining part of the stomach is anastomosed to the jejunum, the procedure is a Billroth II.

A client is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What surgical procedure will the nurse prepare the client for? a. Billroth I b. Vagotomy c. Billroth II d. Pyloroplasty

a. Billroth I Rationale: A Billroth I is the removal of the lower portion (antrum) of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. A vagotomy is a surgical dissection of the vagus nerve to decrease gastric acid. A pyloroplasty is a procedure to widen the pylorus. A Billroth II is the removal of the lower portion (antrum) of stomach with anastomosis to the jejunum.

Which of the following clients is at highest risk for peptic ulcer disease? a. Client with blood type A b. Client with blood type O c. Client with blood type AB d. Client with blood type B

b. Client with blood type O Rationale: Clients with blood type O are more susceptible to peptic ulcers than those with blood types A, B, and AB.

The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding? a. Increased appetite b. Abdominal pain below the umbilicus c. Bloating after meals d. Weight gain

c. Bloating after meals Rationale: Symptoms of progressive disease include bloating after meals, weight loss, abdominal pain above the umbilicus, loss or decrease in appetite, and nausea or vomiting.

Which of the following is the most successful treatment for gastric cancer? a. Chemotherapy b. Radiation c. Palliation d. Removal of the tumor

d. Removal of the tumor Rationale: There is no successful treatment for gastric carcinoma except removal of the tumor. If the tumor can be removed while it is still localized to the stomach, the patient may be cured. If the tumor has spread beyond the area that can be excised, cure is less likely.

Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome? a. Orlistat (Xenical) b. Sibutramine (Meridia) c. Alli d. Rimonabant (Acomplia)

d. Rimonabant (Acomplia) Rationale: Acomplia is the newest medication used to treat obesity. It stimulates weight reduction and improves cardiovascular disease risk factors in obese patients with metabolic syndrome. Meridia was recently pulled from the market because of the increased risk of heart attack and stroke associated with this medication. Orlistat, available by prescription and over the counter as Alli, reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats.

A client with active schizophrenia has developed acute gastritis after ingesting a strongly alkaline solution during a psychotic episode. Which emergency treatments should the nurse anticipate using with the client? Select all that apply. a. Diluted lemon juice b. Aluminum hydroxide c. Diluted vinegar d. Syrup of ipecac e. Gastric lavage

a. Diluted lemon juice c. Diluted vinegar Rationale: Emergency treatment consists of diluting and neutralizing the offending agent. To neutralize acids, common antacids (e.g., 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.

The nurse advises the patient who has just been diagnosed with acute gastritis to: a. Restrict all food for 72 hours to rest the stomach. b. Take an emetic to rid the stomach of the irritating products. c. Restrict food and fluids for 12 hours. d. Refrain from food until the GI symptoms subside.

d. Refrain from food until the GI symptoms subside. Rationale: It usually takes 24 to 48 hours for the stomach to recover from an attack. Refraining from food until symptoms subside is recommended, but liquids should be taken in moderation. Emetics and vomiting can cause damage to the esophagus.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: a. a history of hemorrhoids and smoking. b. alcohol abuse and a history of acute renal failure. c. a sedentary lifestyle and smoking. d. alcohol abuse and smoking.

d. alcohol abuse and smoking. Rationale: The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.

Which ulcer is associated with extensive burn injury? a. Peptic ulcer b. Duodenal ulcer c. Cushing ulcer d. Curling ulcer

d. Curling ulcer Rationale: Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

Clients with Type O blood are at higher risk for which of the following GI disorders? a. Gastric cancer b. Esophageal varices c. Diverticulitis d. Duodenal ulcers

d. Duodenal ulcers Rationale: Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.

A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. a. Famotidine b. Omeprazole c. Nizatidine d. Cimetidine

b. Omeprazole Rationale: Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.

A nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is a. 15% b. Greater than 50% c. 25% d. Less than 5%

a. 15% Rationale: Fifteen percent of clients with peptic ulcer experience bleeding.

A client has been taking famotidine at home. What teaching should the nurse include with the client? a. Famotidine will inhibit gastric acid secretions. b. Famotidine will improve the mixing of foods and gastric secretions. c. Famotidine will neutralize acid in the stomach. d. Famotidine will shorten the time required for digestion in the stomach.

a. Famotidine will inhibit gastric acid secretions. Rationale: Famotidine is useful for treating and preventing ulcers and managing gastroesophageal reflux disease. It functions by inhibiting the action of histamine at the H-2 receptor site located in the gastric parietal cells, thus inhibiting gastric acid secretion. Famotidine will not neutralize acid in the stomach, but inhibits acid secretion. Famotidine will not shorten digestion time and will not improve food mixing with gastric secretions.

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

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

A client who is being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for obstruction which would be indicated by what amount? a. 350 mL b. 450 mL c. 150 mL d. 250 mL

b. 450 mL Rationale: A residual of greater than 400 mL strongly suggests obstruction. Reference:

A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? a. Peptic ulcer b. Curling's ulcer c. Esophageal ulcer d. Meckel's ulcer

b. Curling's ulcer Rationale: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.

Which of the following is the most common complication associated with peptic ulcer? a. Abdominal pain b. Hemorrhage c. Vomiting d. Elevated temperature

b. Hemorrhage Rationale: Hemorrhage, the most common complication, occurs in 28% to 59% of patients with peptic ulcers. Vomiting, elevated temperature, and abdominal pain are not the most common complications of a peptic ulcer.

A client has recently been diagnosed with gastric cancer. On palpation, the nurse would note what two signs that confirm metastasis to the liver? Select all that apply. a. Distended bladder b. Hepatomegaly c. Petechiae at the palpation site d. Ascites e. Sister Mary Joseph's nodules

b. Hepatomegaly d. Ascites Rationale: 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.

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. Hemorrhage b. Inability to clear secretions c. Cachexia d. Pyloric obstruction e. Perforation f. Penetration

a. Hemorrhage d. Pyloric obstruction e. Perforation f. Penetration Rationale: 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.

Which is a true statement regarding the nursing considerations in administration of metronidazole? a. The drug should be given before meals. b. It leaves a metallic taste in the mouth. c. Metronidazole decreases the effect of warfarin. d. It may cause weight gain.

b. It leaves a metallic taste in the mouth. Rationale: Metronidazole leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease gastrointestinal upset. Metronidazole increases the blood-thinning effects of warfarin.

The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol? a. Decreases mucus production b. Works best when taken on an empty stomach c. Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) d. Increases the speed of gastric emptying

c. Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Rationale: Misoprostol (Cytotec) is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.

A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal? a. Slows gastric emptying b. Allows for better absorption of vitamin B12 c. Provides much needed rest d. Removes tension on internal suture line

a. Slows gastric emptying Rationale: Dumping syndrome is a common complication following subtotal gastrectomy. To avoid the rapid emptying of stomach contents, resting after meals can be helpful. Promoting rest after a major surgery is helpful in recovery but not the reason for resting after meals. Following this type of surgery, clients will have a need for vitamin B12 supplementation due to absence of production of intrinsic factor in the stomach. Resting does not increase absorption of B12 or remove tension on suture line.

A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect? a. Vasomotor symptoms associated with dumping syndrome b. Peritonitis c. Dehiscence of the surgical wound d. A normal reaction to surgery

a. Vasomotor symptoms associated with dumping syndrome Rationale: Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? a. "My ulcer will heal because these medications will kill the bacteria." b. "The medications will kill the bacteria and stop the acid production." c. "I should take these medications only when I have pain from my ulcer." d "These medications will coat the ulcer and decrease the acid production in my stomach."

b. "The medications will kill the bacteria and stop the acid production." Rationale: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.

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? a. Gastric ulcer b. Acute gastritis c. Duodenal ulcer d. Gastric cancer

b. Acute gastritis Rationale: A client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccupping, which can last from a few hours to a few days. Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. A client with a duodenal ulcer will present with heartburn, nausea, excessive gas and vomiting. A client with gastric cancer will have persistent symptoms of nausea and vomiting, not sudden symptoms. A client with a gastric ulcer will have bloating, nausea, and vomiting, but not necessarily hiccups.

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? a. Ask the client about his or her plans for after surgery. b. Evaluate the client's understanding of the procedure. c. Rejoice with the client. d. Notify the health care provider that the client is eager to sign the consent form.

b. Evaluate the client's understanding of the procedure. Rationale: The nurse should evaluate the client's understanding of the procedure. The client may not understand that surgery alone isn't a cure for obesity; lifestyle modifications and counseling are also necessary. Based on the client's comment, the client isn't fully informed; therefore, signing an informed consent form without further teaching would be inappropriate. Rejoicing with the client is inappropriate. Asking the client about plans for after surgery redirects the conversation away from the client's misinterpretation of the procedure.

A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? a. "You will not experience GI upset while taking this medication." b. "Do not drive when taking this medication." c. "Be sure to wear sunscreen while taking this medicine." d. "Take the medication with milk."

c. "Be sure to wear sunscreen while taking this medicine." Rationale: Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. GI upset is possible with tetracycline administration. Administration of tetracycline does not necessitate driving restrictions.

A client admitted for treatment of a gastric ulcer is being prepared for discharge. The client will follow a regimen of antacid therapy. Discharge teaching should include which instructions? Choose all that apply. a. "The antacids will make you sleepy, so do not operate machinery while taking them." b. "Be sure to take antacids with meals." c. "You may be prescribed H2-receptor antagonists for up to 1 year." d. "Continue to take antacids even if your symptoms subside." "You may take antacids with other medications."

c. "You may be prescribed H2-receptor antagonists for up to 1 year." d. "Continue to take antacids even if your symptoms subside." "You may take antacids with other medications." Rationale: The client is advised to adhere to and complete the medication regimen to ensure complete healing of the ulcer. Because most clients become symptom-free within 1 week, the nurse stresses the importance of following the prescribed regimen so that the healing process can continue uninterrupted and the return of chronic ulcer symptoms can be prevented. Maintenance dosages of H2-receptor antagonists are usually recommended for 1 year. Taking antacids concomitantly with other drugs should be avoided. For best results antacids should be taken 1 hour before or 2 hours after meals. Antacids will not make the client sleepy.

A client has a family history of stomach cancer. Which factor would further increase the client's risk for developing gastric cancer? Select all that apply. a. European ancestry b. High intake of fruits and vegetables c. Age 55 years d. Previous infection with H. pylori e. Female gender

c. Age 55 years d. Previous infection with H. pylori Rationale: The typical client with gastric cancer is between 40 and 70 years, but gastric cancer can occur in younger people. Men have a higher incidence of gastric cancer than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as European Americans to develop gastric cancer. A diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. Other factors related to the incidence of gastric cancer include chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, subtotal gastrectomy more than 20 years ago, and genetics.

The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction between gastric and duodenal ulcers. a. Presence of H. pylori b. Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) c. Amount of hydrochloric acid (HCL) secretion in the stomach d. Patient's age

c. Amount of hydrochloric acid (HCL) secretion in the stomach Rationale: A duodenal ulcer is characterized by hypersecretion of stomach acid, whereas a gastric ulcer shows evidence of hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects the client's stools to have which description? a. Clay-colored b. Bright red c. Black and tarry d. Coffee-ground-like

c. Black and tarry Rationale: Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.

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? a. Penetration b. Perforation c. Hemorrhage d. Pyloric obstruction

c. Hemorrhage Rationale: Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool. Signs of penetration and perforation are severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate. Indicators of pyloric obstruction are nausea, vomiting, distended abdomen, and abdominal pain.

The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience a. hemorrhage. b. vomiting. c. pain 2 to 3 hours after a meal. d. weight loss.

c. pain 2 to 3 hours after a meal. Rationale: The client with a duodenal ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than in the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? a. "I will weigh myself each day and record the weight." b. "I will call my physician if I begin to have abdominal pain." c. "I'm going to visit my pastor weekly for a while." d. "I will have to take vitamin B12 shots up to 1 year after surgery."

d. "I will have to take vitamin B12 shots up to 1 year after surgery." Rationale: After a total gastrectomy, a client will need to take vitamin B12 shots for life. Dietary B12 is absorbed in the stomach, and the inability to absorb it could lead to pernicious anemia. Visiting clergy for emotional support is normal after receiving a cancer diagnosis. This action should be encouraged by the nurse. It's appropriate for the client to call the physician if he experiences signs and symptoms of intestinal blockage or obstruction, such as abdominal pain. Because a client with a total gastrectomy will receive enteral feedings or parenteral feedings, he should weigh himself each day and keep a record of the weights.

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? a. Place the client in the high-Fowler's position. b. Irrigate the client's NG tube. c. Notify the health care provider. d. Assess the client's abdomen and vital signs.

d. Assess the client's abdomen and vital signs. Rationale: Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

Which medication is classified as a histamine-2 receptor antagonist? a. Lansoprazole b. Metronidazole c. Esomeprazole d. Famotidine

d. Famotidine Rationale: Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.

The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: a. Pyloric obstruction b. Perforation c. Intractable ulcer d. Hemorrhage

d. Hemorrhage Rationale: Hemorrhage, the most common complication, occurs in 10% to 20% of clients with peptic ulcers. Bleeding may be manifested by hematemesis or melena. Perforation is erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Intractable ulcer refers to one that is hard to treat, relieve, or cure. Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.

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? a. Colostomy b. Systemic infection c. Pernicious anemia d. Peptic ulcers

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

A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate? a. Ineffective treatment for the peptic ulcer b. A reaction to the medication given for the ulcer c. Gastric penetration d. Perforation of the peptic ulcer

d. Perforation of the peptic ulcer Rationale: Signs and symptoms of perforation include the following: Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (board-like) abdomen; and hypotension and tachycardia, indicating shock.

A healthcare provider prescribes a combination of drugs to treat reoccurring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client? a The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. b. The antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori. c. The proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori. d. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori.

d. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. Rationale: The recommended combination of bismuth salts, antibiotics, and proton pump inhibitors will suppress or eradicate H. pylori. Prostaglandin E1 analogs enhance mucosal resistance to injury; they do not suppress or eradicate H. pylori.