Adult health Chapter 23 Nursing management - patients with gastric and duodenal disorders

A client with morbid obesity and a history of severe sleep apnea and severe diabetes is being considered for bariatric surgery. When reviewing the client's medical record, the nurse would identify that which body mass index (BMI) would meet the criteria for such surgery?

36 kg/m2

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 with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine. Before the client is discharged, the nurse should provide which instruction?

"Avoid aspirin and products that contain aspirin."

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 nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching?

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

A client who had been prescribed nothing by mouth as treatment for acute gastritis is now reporting a decrease in symptoms and increase in hunger. Which action will the nurse take?

Provide ice chips.

The nurse is caring for a client with chronic gastritis. Which interventions will the nurse add to this client's plan of care? Select all that apply.

Remind to avoid alcohol intake. Review actions to reduce stress. Provide omeprazole as prescribed. Instruct to avoid foods that aggravate the condition.

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

Removal of the tumor

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."

Endoscopy of a 60-year-old woman has revealed the presence of an esophageal peptic ulcer. The nurse who is providing this woman's care is assessing for risk factors that may have contributed to the development of this disease. What question most directly addresses these risk factors?

"Have you ever been diagnosed with reflux?"

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement?

"I have learned some relaxation strategies that decrease my stress."

The nurse instructs a client with acute gastritis on lifestyle modifications. Which client statement indicates that additional teaching is required?

"I will reduce the amount of smoking."

A nurse is conducting discharge teaching for a client who has undergone gastric surgery. After teaching the client about diet, which statement by the client indicates a need for more teaching?

"I'll have meals that have more liquid-like foods than dry ones."

A 70-year-old woman with a complex medical history made an appointment with her primary care provider because she has recently been experiencing heartburn, abdominal pain, and nausea. The clinician has identified that the woman's symptoms are characteristic of acute gastritis. Which of the woman's following statements is suggestive of the etiology of her problem?

"I've changed from taking Tylenol for my arthritis pain to taking aspirin."

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."

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.)

"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin."

An obese male patient has sought advice from the nurse about the possible efficacy of medications in his efforts to lose weight. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity?

"Medications may be of some use, but they don't tend to resolve obesity on their own."

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?

"The medications will kill the bacteria and stop the acid production."

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."

A client weighing 165 lb. (75 kg) is being treated for acute gastritis. Which amount of urine output for 4 hours would indicate an adequate fluid balance if the output should be 1 mL/kg/hour?

300

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

15%

An older adult patient with a diagnosis of chronic gastritis has achieved acceptable control of his condition with the use of an H2 receptor antagonist. This patient's symptom control is a result of what therapeutic action of this drug?

A decrease in HCl production by parietal cells

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 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

A client with chronic peptic ulcers is considering a vagotomy. Which information will the nurse provide to the client about this surgical procedure?

Adverse effects such as dumping syndrome and gastritis can occur.

The nurse is caring for a client with a feeding tube in place who has been prescribed bolus tube feedings. Which consideration(s) should the nurse take into account while administering the client's plan of care? Select all that apply.

Allow introduction of between 8.5 and 13.5 oz (250 and 400 mL) formula through the tube in a short period (usually 15 to 30 minutes). Administer by syringe or gravity flow system attached to the distal end of the feeding tube. Administer usually three to four times daily.

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.

Amount of hydrochloric acid (HCL) secretion in the stomach

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.

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?

Awakening in pain

A young adult client is prescribed misoprostol to prevent gastric ulcers caused by frequent use of nonsteroidal anti-inflammatory agents for an autoimmune disorder. For which reason will the nurse question giving the client a dose of this medication?

Awaiting the results of a pregnancy test

A client has been diagnosed with chronic gastritis. The nurse knows that which of the following symptoms are indicative of gastritis? Select all that apply.

Belching Early satiety Sour taste in the mouth

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?

Billroth I

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

The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding?

Bloating after meals

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

Client with blood type O

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 ulcer is associated with extensive burn injury?

Curling ulcer

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?

Curling's ulcer

A client 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 client reported cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the nurse educate the client about regarding this event?

Dumping syndrome

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

Duodenal ulcers

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

Which term refers to the first portion of the small intestine?

Duodenum

A patient comes to the clinic complaining of pain in the epigastric region. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by what?

Eating

A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that, in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what?

Emotional stability and understanding of required lifestyle changes.

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

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

Famotidine

A client has been taking famotidine at home. What teaching should the nurse include with the client?

Famotidine will inhibit gastric acid secretions.

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

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

Which of the following is the most common complication associated with peptic ulcer?

Hemorrhage

A critical care nurse is closely monitoring a patient who has recently undergone surgical repair of a bleeding peptic ulcer. The nurse should prioritize assessments of which of the following signs and symptoms of a recurrence of hemorrhage?

Hypotension and tachycardia

A client reports diarrhea after having bariatric surgery. What nonpharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea?

Increase the fiber content in the diet.

A patient presents to the walk-in clinic complaining of vomiting and burning in his mid-epigastria. The nurse knows that to confirm peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what?

Infection with Helicobacter pylori

Computed tomography of a patient with a sudden onset of severe nausea and vomiting has revealed the presence of a pyloric obstruction. Which of the following interventions is the nurse's priority in the immediate care of this patient?

Insertion of a nasogastric (NG) tube to suction to decompress the stomach

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.

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

An older adult patient had a gastrectomy performed several weeks ago and is being followed closely by the care team. Due to potential complications of this surgery, the nurse should closely monitor the patient's levels of:

Iron and vitamin B12

A 32-year-old man who has a body mass index of 32 (morbidly obese) is considering bariatric surgery. In the time leading up to this surgery, which of the following nursing diagnoses will be the primary focus of interventions?

Knowledge deficit related to the implications of bariatric surgery

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

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

Mental confusion

Which is a true statement regarding gastric cancer?

Most clients are asymptomatic during the early stage of the disease.

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

Nasogastric tube insertion

The nurse is performing detailed patient education with a 40-year-old woman who will be soon discharged following a Roux-en-Y gastric bypass. The nurse and other members of the interdisciplinary team have been emphasizing the need for eating small amounts of food at a sitting and eating food slowly. What is the rationale for the nurse's advice?

Nausea and esophageal distention can result from eating too fast.

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

Nizatidine Famotidine Cimetidine

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 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.

Omeprazole

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

Omeprazole

A patient asks the home health nurse from what the distressing symptoms of dumping syndrome result. What physiological occurrence should the nurse explain?

Osmotic transport of extracellular fluid into the gastrointestinal tract

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?

Perforation of the peptic ulcer

A 30-year-old obese female patient who underwent gastric banding 3 days ago is getting ready to go home. Essential postoperative teaching for this patient should include instruction related to the importance of abstaining from what for the next 2 years?

Pregnancy

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply.

Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas

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?

Slows gastric emptying

The nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below should the nurse consider most significantly related to the etiology of the patient's health problem?

Smokes two packs of cigarettes daily

After a client received a diagnosis of gastric cancer, the surgical team decides that a Billroth II would be the best approach to treatment. How would the nurse explain this procedure to the family?

Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach

The nurse is preparing a teaching tool about delayed release proton pump inhibitors used to treat duodenal ulcer disease caused by H. pylori. Which statement will the nurse include that would apply to most types of proton pump inhibitor prescribed to treat this condition?

The medication is to be swallowed whole and taken before meals

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?

Vasomotor symptoms associated with dumping syndrome

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to:

drink liquids only between meals.

A nurse assesses the stools of a client diagnosed with peptic ulcer disease. Inspection reveals black, tarry stools. The nurse would use which term to document this finding?

melena

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

pain 2 to 3 hours after a meal.

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected gastrointestinal problem. The client reports gnawing epigastric pain following meals and heartburn. What would the nurse suspect this client has?

peptic ulcer disease