PrepU Chapter 46 Gastric & Duodenal Disorders (PUD)

A client reports to the clinic, stating that she rapidly developed headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. For dinner, she ate buffalo chicken wings and beer. Which of the following medical conditions is most consistent with the client's presenting problems? -Acute gastritis -Duodenal ulcer -Gastric cancer -Gastric ulcer

-Acute gastritis The client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccuping, 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 physician has written an order for ranitidine (Zantac), 300 mg once daily. The nurse schedules the medication for which time? -At bedtime -After lunch -With supper -Before breakfast

-At bedtime 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 (eg, metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (eg, 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.

Which of the following appears to be a significant factor in the development of gastric cancer? -Diet -Age -Ethnicity -Gender

-Diet Diet seems to be a significant factor: a diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. The typical patient with gastric cancer is between 50 and 70 years of age. Men have a higher incidence than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop gastric cancer.

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

-Severe peptic ulcers -Extreme gastric hyperacidity -Gastrin-secreting tumors of the pancreas 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 with peptic ulcer disease wants to know nonpharmacologic ways that he can prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. -Smoking cessation -Substitution of coffee with decaffeinated products -Avoidance of alcohol -Eating whenever hungry -Following a regular schedule for rest, relaxation, and meals

-Avoidance of alcohol -Smoking cessation -Following a regular schedule for rest, relaxation, and meals The likelihood of recurrence is reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, and alcohol. It is important to counsel the client to eat meals at regular times and in a relaxed setting and to avoid overeating.

Peptic ulcer disease occurs more frequently in people with which blood type? -A -B -AB -O

-O People with blood type O are more susceptible to peptic ulcers than those with blood type A, B, or AB.

The nurse is caring for a client with chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? -Vitamin A -Vitamin B12 -Vitamin C -Vitamin E

-Vitamin B12 Clients with chronic gastritis from vitamin deficiency usually have evidence of malabsorption of vitamin B12 caused by the production of antibodies that interfere with the binding of vitamin B12 to intrinsic factor. However, some clients with chronic gastritis have no symptoms. Vitamins A, C, and E are not affected by gastritis.

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 -Bradycardia -Hypertension -Polyuria

-Hematemesis 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.

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

-Pernicious anemia -Macrocytic anemia -Thrombocytopenia Decreased vitamin B12 can result in pernicious anemia, macrocytic anemia, and thrombocytopenia. Decreased iron can result in lethargy and loss of hair.

The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. The nurse recognizes that an agent that is used to decrease bleeding and decrease gastric acid secretions is -ranitidine (Zantac) -omeprazole (Prilosec) -vasopressin (Pitressin) -octreotide (Sandostatin)

-octreotide (Sandostatin) For patients with ZES, hypersecretion of acid may be controlled with high doses of H2 receptor antagonists. These clients may require twice the normal dose, and dosages usually need to be increased with prolonged use. Octreotide (Sandostatin), a medication that suppresses gastrin levels, also may be prescribed.

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

-Duodenal ulcers 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.

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? -Duodenum -Esophagus -Pylorus -Stomach

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

During assessment of a patient with gastritis, the nurse practitioner attempts to distinguish acute from chronic pathology. One criteria, characteristic of gastritis would be the: -Immediacy of the occurrence. -Presence of vomiting. -Frequency of abdominal discomfort. -Incidence of anorexia.

-Immediacy of the occurrence. Acute gastritis usually develops quickly, whereas chronic gastritis results from prolonged inflammation of the stomach.

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 = 150 lbs; weight = 190 lbs; BMI = 26 kg/m2 -IBW = 132 lbs; weight = 184 lbs; BMI = 28 kg/m2 -IBW = 175 lbs; weight = 265 lbs; BMI = 29 kg/m2 -IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2

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

The client has been taking famotidine (Pepcid) at home. The nurse prepares a teaching plan for the client indicating that the medication acts primarily to achieve which of the following? -Inhibit gastric acid secretions. -Neutralize acid in the stomach. -Shorten the time required for digestion in the stomach. -Improve the mixing of foods and gastric secretions.

-Inhibit gastric acid secretions. 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.

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

-Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Misoprostol 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.

The nurse is conducting a community education program on peptic ulcer disease prevention. The nurse includes that the most common cause of peptic ulcers is: -stress and anxiety. -gram-negative bacteria. -alcohol and tobacco. -ibuprofen and aspirin.

-gram-negative bacteria. The nurse should include that the most common cause of peptic ulcers is gram-negative bacteria (Helicobacter pylori).

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

-It leaves a metallic taste in the mouth. 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 evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? -Vomiting -Hemorrhage -Awakening in pain -Weight loss

-Awakening in pain The client with a gastric ulcer often awakens between 1 to 2 AM with pain, and ingestion of food brings relief. Vomiting is uncommon in clients with duodenal ulcer. Hemorrhage is less likely in clients with duodenal ulcer than those with gastric ulcer. The client with a duodenal ulcer may experience weight gain.

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. The nurse suspects: -Vasomotor symptoms associated with dumping syndrome -Dehiscence of the surgical wound -Peritonitis -A normal reaction to surgery

-Vasomotor symptoms associated with dumping syndrome 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, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

A client experienced extensive burns and 72 hours later has developed an ulcer. Which of the following types of ulcer is most likely in this client? -Stress ulcer -Curling's ulcer -Cushing's ulcer -Hashimoto's ulcer

-Curling's ulcer Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or 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 sectioned portion of the stomach is joined to the jejunum. -The antral portion of the stomach is removed and a vagotomy is performed. -The vagus nerve is cut and gastric drainage is established.

-A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. 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 nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has: -peptic ulcer disease. -ulcerative colitis. -appendicitis. -diverticulitis.

-peptic ulcer disease. Peptic ulcer disease is characterized by dull, gnawing pain in the midepigastrium or the back that worsens with eating. Ulcerative colitis is characterized by exacerbations and remissions of severe bloody diarrhea. Appendicitis is characterized by epigastric or umbilical pain along with nausea, vomiting, and low-grade fever. Pain caused by diverticulitis is in the left lower quadrant and has a moderate onset. It's accompanied by nausea, vomiting, fever, and chills.

A client with gastric cancer is scheduled to undergo a Billroth II procedure. The client's spouse asks how much of the client's stomach will be removed. Which of the following would be the most accurate response from the nurse? -Approximately 25% -Approximately 50% -Approximately 75% -The amount will depend on the client's weight.

-Approximately 75% The Billroth II is a wide resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence.

Symptoms associated with pyloric obstruction include all of the following except: -Anorexia -Diarrhea -Nausea and vomiting -Epigastric fullness

-Diarrhea 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 client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

The nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required? -1.0 L -1.5 L -2.0 L -2.5 L

-1.5 L Daily fluid intake and output are monitored to detect early signs of dehydration (minimal fluid intake of 1.5 L/day, minimal output of 0.5 mL/kg/h).

Morbid obesity is defined as being how many pounds over the person's ideal body weight? -100 -90 -75 -50

-100 Morbid obesity is a term applied to people who are more than two times their ideal body weight or whose body weight index (BMI) exceeds 30 kg/m2. Another definition of morbid obesity is body weight that is more than 100 pounds greater than the ideal body weight.

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 -Less than 5% -15% -25% -Greater than 50%

-15% Fifteen percent of clients with peptic ulcer experience bleeding.

A client weighs 215 lbs and is 5' 8" tall. The nurse would calculate this client's body mass index (BMI) as which of the following? -19.5 -24.8 -32.7 -44.9

-32.7 Using the formula for BMI, the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703. The result would be 32.7.

Which of the following clients is at highest risk for peptic ulcer disease? -Client with blood type A -Client with blood type B -Client with blood type AB -Client with blood type O

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

Which ulcer is associated with extensive burn injury? -Cushing ulcer -Curling ulcer -Peptic ulcer -Duodenal ulcer

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

A patient 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 patient? -Curling's ulcer -Peptic ulcer -Esophageal ulcer -Meckel's ulcer

-Curling's ulcer Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

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

-Mental confusion Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.

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

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

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client states: -"I should stop all my medications if I develop any side effects." -"I should continue my treatment regimen as long as I have pain." -"I have learned some relaxation strategies that decrease my stress." -"I can buy whatever antacids are on sale because they all have the same effect."

-"I have learned some relaxation strategies that decrease my stress." The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.

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

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

A client is prescribed tetracycline to treat peptic ulcer disease. Which of the following instructions would the nurse give the client? -"Take the medication with milk." -"Be sure to wear sunscreen while taking this medicine." -"Expect a metallic taste when taking this medicine, which is normal." -"Do not drive when taking this medication."

-"Be sure to wear sunscreen while taking this medicine." 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. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.

A nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which of the following explanations from the nurse would be most accurate? -"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." -"Caffeine increases the fluid volume in your system, which irritates your digestive organs." -"Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." -"Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems."

-"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." Caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Caffeine is a diuretic that causes decreased fluid volume and potential dehydration. It does not lead to hemorrhage and does not interfere with absorption of vitamin B12.

After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? -"I need to chew my food slowly and thoroughly." -"I need to drink 8 ounces of water before eating." -"A total serving should amount to be less than one cup." -"I should pick cereals with less than 2 g of fiber per serving."

-"I need to drink 8 ounces of water before eating." After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withholding fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly, keeping total serving sizes to less than 1 cup, and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving.

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

-"I will have to take vitamin B12 shots up to 1 year after surgery." 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.

A nurse is teaching a client who has experienced an episode of acute gastritis and knows further education is necessary when the client makes the following statement: -"I should feel better in about 24 to 36 hours." -"My appetite should come back tomorrow." -"I should limit alcohol intake, at least until symptoms subside." -"Once I can eat again, I should stick with bland foods."

-"My appetite should come back tomorrow." The gastric mucosa is capable of repairing itself after an episode of gastritis. As a rule, the client recovers in about 1 day, although the appetite may be diminished for an additional 2 or 3 days. Acute gastritis is also managed by instructing the client to refrain from alcohol and food until symptoms subside. When the client can take nourishment by mouth, a nonirritating diet is recommended.

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

-"The medications will kill the bacteria and stop the acid production." 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 (eg, metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (eg, 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 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. -High intake of fruits and vegetables -Age 55 years -Female gender -Caucasian ancestry -Previous infection with H. pylori

-Age 55 years -Previous infection with H. pylori 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 Caucasian 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 is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75? -Abdominal mass -Agitation -Hepatomegalia -Ascites

-Agitation The nurse understands that agitation, along with confusion and restlessness, may be the only signs/symptoms seen of gastric cancer in the older client. Abdominal mass, hepatomegaly, and ascites may all be signs/symptoms of advanced gastric cancer.

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. -Amount of hydrochloric acid (HCL) secretion in the stomach -Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) -Presence of H. pylori -Patient's age

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

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 to his right shoulder. The intial appropriate action by the nurse is to -Notify the health care provider. -Irrigate the client's NG tube. -Place the client in the high-Fowler's position. -Assess the client's abdomen and vital signs.

-Assess the client's abdomen and vital signs. 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.

The health care provider prescribes a combination of three drugs to treat peptic ulcer disease. The nurse, preparing to review the drug actions and side effects with the patient, understands that the triple combination should be in which order? -Antibiotics, prostaglandin E1 analogs, and bismuth salts -Proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts -Bismuth salts, antibiotics, and proton pump inhibitors -Prostaglandin E1 analogs, antibiotics, and proton pump inhibitors

-Bismuth salts, antibiotics, and proton pump inhibitors Refer to Table 23-1 in the text to review the recommended triple combination.

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. -Burning sensation localized in the back or mid-epigastrium -Feeling of emptiness that precedes meals from 1 to 3 hours -Severe gnawing pain that increases in severity as the day progresses -Pain that radiates to the shoulder or jaw -Vomiting without associated nausea

-Burning sensation localized in the back or mid-epigastrium -Feeling of emptiness that precedes meals from 1 to 3 hours -Severe gnawing pain that increases in severity as the day progresses As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the mid-epigastrium or the back. Although vomiting is rare in uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer.

A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history: -Coronary artery disease -Diabetes -Use of lithium -Peptic ulcer disease

-Coronary artery disease Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.

A nurse caring for a patient in a burn treatment center knows to assess for the presence of which of the following types of ulcer about 72 hours post injury? -Peptic -Cushing's -Gastric -Curling's

-Curling's Curling's ulcer results from a complication from severe burns that causes reduced plasma volume that affects the gastric mucosa. Cushing's ulcer is produced by elevated intracranial pressure and is common with head injuries and brain trauma.

A patient is complaining of diarrhea after having bariatric surgery. What nonpharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea? -Decrease the fat content in the diet. -Increase the fiber content in the diet. -Decrease the amount of fluid the patient is drinking. -Increase the protein content in the diet.

-Decrease the fat content in the diet. Patients may complain of either diarrhea or constipation postprocedure. Diarrhea is more common an occurrence post bariatric surgery, particularly after malabsorptive procedures (Mechanick et al., 2008). Both may be prevented if the patient consumes a nutritious diet that is high in fiber. Steatorrhea also may occur as a result of rapid gastric emptying, which prevents adequate mixing with pancreatic and biliary secretions. In mild cases, reducing the intake of fat and administering an antimotility medication (e.g., loperamide [Imodium]) may control symptoms.

A patient who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the patient be educated about regarding this event? -Gastric outlet obstruction -Dumping syndrome -Bile reflux -Celiac disease

-Dumping syndrome Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery. Early symptoms include a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. These symptoms resolve once the intestine has been evacuated (i.e., with defecation).

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. -Ranitidine (Zantac) -Cimetidine (Tagamet) -Famotidine (Pepcid) -Omeprazole (Prilosec)

-Omeprazole (Prilosec) 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 physician suspects that a client has peptic ulcer disease. With which of the following diagnostic procedures would the nurse most likely prepare to assist? -Barium study of the upper gastrointestinal tract -Endoscopy -Gastric secretion study -Stool antigen test

-Endoscopy 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.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? -Upper GI series -Endoscopy -Hemoglobin and hematocrit -Arteriography

-Hemoglobin and hematocrit The nurse assesses for faintness or dizziness and nausea, which may precede or accompany bleeding. It is important to monitor vital signs frequently and to evaluate for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production). If bleeding cannot be managed by the measures described, other treatment modalities such as endoscopy may be used to halt bleeding and avoid surgical intervention. There is debate regarding how soon endoscopy should be performed. Some clinicians believe endoscopy should be performed within the first 24 hours after hemorrhaging has ceased. Others believe endoscopy may be performed during acute bleeding, as long as the esophageal or gastric area can be visualized (blood may decrease visibility). An upper GI is less accurate than endoscopy and would not reveal a bleed. Arteriography is an invasive study associated with life-threatening complications and would not be used for an initial evaluation.

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: -Hemorrhage -Intractable ulcer -Perforation -Pyloric obstruction

-Hemorrhage 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.

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, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed? -Hemorrhage -Penetration -Perforation -Pyloric obstruction

-Hemorrhage 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.

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 -Bladder -Duodenum -Lungs

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

Which is a true statement regarding gastric cancer? -Most clients are asymptomatic during the early stage of the disease. -Women have a higher incidence of gastric cancer. -The prognosis for gastric cancer is good. -Most cases are discovered before metastasis.

-Most clients are asymptomatic during the early stage of the disease. Most clients are asymptomatic during the early stage of the disease. Men have a higher incidence of gastric cancer. The prognosis is poor because the diagnosis is usually made late because most clients are asymptomatic during the early stage. Most cases of gastric cancer are discovered only after local invasion has advanced or metastases are present.

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? -Pelvic x-ray -Stool specimen -Nasogastric tube insertion -Oral contrast

-Nasogastric tube insertion 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 client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? -Notify the physician. -Reposition the tube. -Irrigate the tube. -Increase the suction level.

-Notify the physician. The nurse should notify the physician because an NG tube that fails to drain during the postoperative period may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.

Which medication classification represents a proton (gastric acid) pump inhibitor? -Omeprazole -Sucralfate -Famotidine -Metronidazole

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

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

-Perforation of the peptic ulcer 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 (boardlike) abdomen; and hypotension and tachycardia, indicating shock.

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

-Refrain from food until the GI symptoms subside. 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.

Which of the following is the most successful treatment for gastric cancer? -Removal of the tumor -Chemotherapy -Radiation -Palliation

-Removal of the tumor 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? -Rimonabant (Acomplia) -Orlistat (Xenical) -Alli -Sibutramine (Meridia)

-Rimonabant (Acomplia) 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 health care provider counsels a patient about bariatric surgery. He recommends the Roux-en-Y gastric bypass. The nurse explains to the patient that this procedure involves which of the following? -Gastroplasty with a vertical band allowing for a pouch with a 15 to 20 mL capacity -Biliopancreatic diversion with a duodenal switch -Separation of the jejunum with an anastomosis -Gastric banding that incorporates a prosthetic device to restrict oral intake

-Separation of the jejunum with an anastomosis The Roux-en-Y gastric bypass is recommended for long-term weight loss because it uses a combined restrictive and malabsorptive procedure. Refer to Figure 23-3 (A to D) in the text.

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. -Tachycardia -Hypotension -Mild epigastric pain -A rigid, board-like abdomen -Diarrhea

-Tachycardia -Hypotension -A rigid, board-like abdomen Signs and symptoms of perforation include sudden, severe upper abdominal pain (persisting and increasing in intensity); pain, 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. Perforation is a surgical emergency.

Which is an accurate statement regarding gastric cancer? -The incidence of stomach cancer continues to decrease in the United States. -Most gastric cancer-related deaths occur in people younger than 40 years. -Females have a higher incidence of gastric cancers than males. -A diet high in smoked foods and low in fruits and vegetables may decrease the risk of gastric cancer.

-The incidence of stomach cancer continues to decrease in the United States. While the incidence in the United States continues to decrease, gastric cancer still accounts for 10,700 deaths annually. While gastric cancer deaths occasionally occur in younger people, most occur in people older than 40 years of age. Males have a higher incidence of gastric cancers than females. More accurately, a diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.

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

-Vomiting is uncommon in clients with duodenal ulcers. 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.

After a client received a diagnosis of gastric cancer, the surgical team decides that a Billroth II would be the best approach to treatment. The nurse explains to the family that this procedure involves: -Limited resection in the distal portion of the stomach and removal of about 25% of the stomach -Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach -Proximal subtotal gastrectomy -Total gastrectomy and esophagogastrectomy

-Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach The Billroth I involves a limited resection and offers a lower cure rate than the Billroth II. The Billroth II procedure is a wider resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence. A proximal subtotal gastrectomy may be performed for a resectable tumor located in the proximal portion of the stomach or cardia. A total gastrectomy or an esophagogastrectomy is usually performed in place of this procedure to achieve a more extensive resection.

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 sedentary lifestyle and smoking. -a history of hemorrhoids and smoking. -alcohol abuse and a history of acute renal failure. -alcohol abuse and smoking.

-alcohol abuse and smoking. 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.

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be: -coffee-ground-like. -clay-colored. -black and tarry. -bright red.

-black and tarry. 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.

The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid -acetaminophen. -decaffeinated coffee. -skim milk. -octreotide.

-decaffeinated coffee. The nurse should include avoidance of decaffeinated coffee in the client's discharge teaching plan. Decaffeinated coffee is avoided to keep from overstimulating acid secretion.

A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. The nurse suspects the client has: -dumping syndrome. -dehiscence of the surgical wound. -peritonitis. -a normal reaction to surgery.

-dumping syndrome. 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, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.