ch23: gastric
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. What would be the most accurate response from the nurse? Approximately 75% Approximately 25% The amount will depend on the client's weight. Approximately 50%
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.
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? Gastric ulcer Gastric cancer Acute gastritis Duodenal ulcer
Acute gastritis 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.
A client is admitted with a new onset of pyloric obstruction. What client symptoms should the nurse anticipate? Select all that apply. Anorexia Nausea and vomiting Diarrhea Weight loss Epigastric fullness
Anorexia Nausea and vomiting Epigastric fullness 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, and anorexia. A later sign will be weight loss. The client will not have diarrhea with the obstruction.
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? Celiac disease Bile reflux Dumping syndrome Gastric outlet obstruction
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 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 Celiac disease Bile reflux Gastric outlet obstruction
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).
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 nurse is preparing to administer ondansetron to an older adult client to prevent nausea and vomiting due to a chronic health condition. What safety warning(s) should the nurse consider when administering the medication? Select all that apply. Note that dehydration is greater when used in older adults. Emphasize prevention and take consistently to prevent nausea and vomiting. Start before travel to be effective. Do not use if the client has heart block or prolonged QT interval. Client will have increased sedation if used with opiates.
Emphasize prevention and take consistently to prevent nausea and vomiting. Do not use if the client has heart block or prolonged QT interval. Client will have increased sedation if used with opiates. Not using the medication if the client has a heart block or prolonged QT interval, noting that there will be increased sedation if used with opiates, emphasizing prevention, and advising that the client must take the medication consistently to prevent nausea and vomiting are all safety warnings that the nurse should consider when administering ondansetron. Taking the medication before travel is applicable to antivertigo medications such as dimenhydrinate. Dehydration being greater when used in older adults is applicable to antidopaminergic drugs such as prochlorperazine.
A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? Gastric secretion study Barium study of the upper gastrointestinal tract Stool antigen test Endoscopy
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.
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 = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 IBW = 175 lbs; weight = 265 lbs; BMI = 29 kg/m2 IBW = 150 lbs; weight = 190 lbs; BMI = 26 kg/m2 IBW = 132 lbs; weight = 184 lbs; BMI = 28 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.
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? "My appetite may increase while taking this medication." "I can take this medication with my blood thinner." "I can have an alcoholic drink in the evenings." "It might cause a metallic taste in my mouth."
It might cause a metallic taste in my mouth." Metronidazole is a synthetic antibacterial and antiprotozoal agent that assists with eradicating H. pylori bacteria in the gastric mucosa when given with other antibiotics and proton pump inhibitors. This medication may cause a metallic taste in the mouth. It should not be taken with anticoagulants as it will increase the blood thinning effects of warfarin. Alcohol should be avoided while taking this medication. This medication may cause anorexia and not an increased appetite.
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. Encourage the client to drink a warm beverage. Provide a dose of a proton pump inhibitor. Discuss the types of foods the client has been eating.
Notify the primary health care provider. The client with peptic ulcer disease is demonstrating signs of hemorrhage which include cool skin and tachycardia. The health care provider should be immediately notified. The client should not be given any additional medication. A warm beverage could enhance bleeding. It is inappropriate to provide any teaching while the client is experiencing an acute condition.
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? Three meals and three snacks and 120 mL fluid daily Three meals 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 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? Removes tension on internal suture line Allows for better absorption of vitamin B12 Provides much needed rest Slows gastric emptying
Slows gastric emptying 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 patient is recovering in the PACU following gastric surgery. The nurse who is providing this patient's care is performing frequent assessments of the character and quantity of the patient's nasogastric (NG) drainage. What are the nurse's expected findings during these assessments? Moderate amounts of clear output Scant amounts of greenish-colored output Copious quantities of straw-colored output Small amounts of blood-tinged output
Small amounts of blood-tinged output Following gastric surgery, the nurse assesses NG drainage for type and amount; some bloody drainage for the first 12 hours is expected, but excessive bleeding should be reported.
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 Interferes with the metabolism of digoxin, iron, and warfarin May cause diarrhea and hyperglycemia Abdominal pain and abnormal liver function tests are expected effects
The medication is to be swallowed whole and taken before meals There are several proton pump inhibitors used to treat duodenal ulcers caused by H. pylori. For most of these medications, they are a delayed-release capsule that is to be swallowed whole and taken before meals. Pantoprazole may cause diarrhea and hyperglycemia. Rabeprazole is the only proton pump inhibitor that interferes with the metabolism of digoxin, iron, and warfarin. Rabeprazole may cause abdominal pain. Pantoprazole may cause abnormal liver function tests.
A client recovering from a total gastrectomy has a low red blood cell count. Which medication will the nurse expect to be prescribed for this client? Oral iron tablets Vitamin B12 injections Transfusions of packed RBCs Erythropoietin injections
Vitamin B12 injections Intrinsic factor is secreted by the parietal cells in the stomach, which binds to vitamin B12 so it can be absorbed in the ileum. With the loss of some parietal cells, there is a deficiency in vitamin B12, which leads to a decreased production of red blood cells or pernicious anemia. Treatment would be vitamin B12 injections for life. Oral iron tablets would be prescribed for iron deficiency anemia. Erythropoietin injections would be prescribed for anemia caused by kidney disease. The client is not actively bleeding and would not need transfusions of packed RBCs.
A client with morbid obesity is being scheduled for malabsorptive bariatric surgery. The nurse would provide teaching about which procedure? biliopancreatic diversion sleeve gastrectomy Roux-en-Y gastric bypass gastric banding
biliopancreatic diversion Gastric restrictive procedures, such as adjustable gastric banding (AGB), vertical banded gastroplasty and sleeve gastrectomy (SG), cause early satiety during meals by decreasing the volume of the stomach. Malabsorptive procedures, such as biliopancreatic diversion with or without duodenal switch (BPD/DS), rely on bypassing various lengths of the small intestine, reducing nutrient absorption. Mixed procedures such as the Roux-en-Y gastric bypass (RYGB) combine gastric restriction with bypass of a short segment of the small intestine.
The nurse instructs a client with acute gastritis on lifestyle modifications. Which client statement indicates that additional teaching is required? "I will avoid alcoholic beverages." "I will reduce the amount of smoking." "I will switch to decaffeinated coffee." "I will increase my intake of fresh fruit."
"I will reduce the amount of smoking." Lifestyle modifications for the client with acute gastritis focus on smoking, alcohol intake, and caffeine. Smoking should be discouraged because the level of nicotine in gastric acid can be 10 times greater than in arterial blood and 80 times greater than venous blood. Alcohol intake should also be discouraged. Caffeinated beverages should also be discouraged because caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Increasing the intake of fresh fruit is not identified as a lifestyle modification for acute gastritis.
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." "Is it possible that you are overusing aspirin." "It is probably your nerves." "It is a hereditary disease." "You may have ingested some irritating foods."
"It can be caused by ingestion of strong acids." "Is it possible that you are overusing aspirin." "You may have ingested some irritating foods." 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 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 25% 15% Greater than 50% Less than 5%
15%
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 sectioned portion of the stomach is joined to the jejunum. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. 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 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.
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 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 shows evidence of hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.
The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan? Select all that apply. Checking the blood pressure and pulse rate every 15 to 20 minutes Inserting an indwelling catheter for incontinence Making neurovascular checks every 4 hours Observing stools and vomitus for color, consistency, and volume Frequently monitoring hemoglobin and hematocrit levels
Checking the blood pressure and pulse rate every 15 to 20 minutes Observing stools and vomitus for color, consistency, and volume Frequently monitoring hemoglobin and hematocrit levels The nurse assesses the patient for faintness or dizziness and nausea, which may precede or accompany bleeding. The nurse must monitor vital signs frequently and evaluate the patient 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).
Which ulcer is associated with extensive burn injury? Curling ulcer Peptic ulcer Duodenal ulcer Cushing 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 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? Excessive stomach acid secretion Inadequate production of pancreatic enzymes Infection with Helicobacter pylori Gastric irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs)
Infection with Helicobacter pylori H. pylori infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen. Other 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. Excessive stomach acid secretion, NSAIDs, and dietary indiscretion may all cause gastritis; however, peptic ulcers are caused by colonization of the stomach by H. pylori.
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience hemorrhage. pain 2 to 3 hours after a meal. vomiting. weight loss.
pain 2 to 3 hours after a meal. 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.