Chapter 23: Nursing Management: Patients With Gastric and Duodenal Disorders

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 explanation from the nurse would be most accurate? A. "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." B. "Caffeine increases the fluid volume in your system, which irritates your digestive organs." C. "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." D. "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems."

A. "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.

A client with peptic ulcer disease caused by H. pylori is prescribed clarithromycin. Which information will the nurse include when teaching the client about this medication? A. Do not take this medication with grapefruit juice. B. Always take this medication on an empty stomach. C. Photosensitivity is an adverse effect of this medication. D. Abdominal pain and diarrhea are expected side effects

A. Do not take this medication with grapefruit juice. Clarithromycin is an antibiotic used to treat H. pylori infection. This medication should not be taken with grapefruit juice. Photosensitivity is an adverse effect of tetracycline. Amoxicillin can cause abdominal pain and diarrhea. Metronidazole can be taken with meals to decrease GI upset.

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

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

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

A. Severe gnawing pain that increases in severity as the day progresses B. Burning sensation localized in the back or mid-epigastrium C. Feeling of emptiness that precedes meals from 1 to 3 hours 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.

The nurse practitioner counsels a patient about being a candidate for bariatric surgery. The patient is 5?4? tall and weighs 300 pounds (IBW is 125 lbs). The nurse tells the patient that, based on the average weight loss after surgery, she should expect to eventually weigh: A. 160 lbs. B. 120 lbs. C. 180 lbs. D. 140 lbs.

B. 120 lbs. Research has shown that the average weight loss after bariatric surgery is about 60% of previous body weight. If the patient weighed 300 lbs, 60% would be 180 lbs. Subtract: 300 - 180 = 120 lbs.

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? A. Approximately 50% B. Approximately 75% C. Approximately 25% D. The amount will depend on the client's weight.

B. 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 health care provider counsels a client about bariatric surgery and recommends the Roux-en-Y gastric bypass. What is the best response by the nurse to further explain this procedure to the client? A. Gastroplasty with a vertical band allowing for a pouch with a 15 to 20 mL capacity B. Separation of the jejunum with an anastomosis C. Biliopancreatic diversion with a duodenal switch D. Gastric banding that incorporates a prosthetic device to restrict oral intake

B. 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.

A nurse is preparing to discharge a patient who had gastric surgery. What is an appropriate discharge outcome for this patient? A. The patient consumes a diet high in calcium. B. The patient maintains or gains weight. C. The patient's bowel movements are loose. D. The patient eats three meals a day.

B. The patient maintains or gains weight. Expected outcomes for the patient following gastric surgery include daily weights to ensure that the patient is maintaining or gaining weight, experiencing no excessive diarrhea, and tolerating six small meals a day. Patients may require vitamin B12 supplementation by the intramuscular route and do not require a diet excessively rich in calcium.

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? A. Allergic response to the medication B. Medication adverse effects C. Bleeding from the ulcer D. Evidence of ulcer healing

C. Bleeding from the ulcer Bleeding peptic ulcers account for 27% to 40% of all upper GI bleeds and it may be manifested by hematemesis or melena. Faintness or dizziness and nausea may precede or accompany bleeding. A low blood pressure could indicate active bleeding. The client's symptoms do not indicate evidence of the ulcer healing. It is unlikely that the client's symptoms are adverse effects or allergic responses to the medications.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A. Upper GI series B. Endoscopy C. Hemoglobin and hematocrit D. Arteriography

C. 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.

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. Aluminum hydroxide B. Syrup of ipecac C. Gastric lavage D. Diluted vinegar E. Diluted lemon juice

D. Diluted vinegar E. Diluted lemon juice 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.

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 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 client is newly diagnosed with a gastric outlet obstruction. Which topic will the nurse include in client education? A. Surgical management options B. Weight gain management options C. Management of right lower quadrant pain D. Management of constipation

D. Management of constipation Peptic ulcer disease is the leading benign cause of gastric outlet obstruction. Gastric outlet obstruction 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. In treating the client with gastric outlet obstruction, the first consideration is to insert an NG tube to decompress the stomach. Confirmation that obstruction is the cause of the discomfort is accomplished by assessing the amount of fluid aspirated from the NG tube. A residual of more than 400 mL suggests obstruction. Black tarry runny stools occur from bleeding somewhere in the GI tract. Hyperactive bowel sounds can occur with many health conditions. Right lower quadrant abdominal pain is associated with appendicitis.

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? A. insertion of a nasogastric (NG) tube to suction to decompress the stomach B. Gastric lavage C. Administration of a saline enema to purge the lower bowel D. Insertion of a central line for parenteral nutrition

A. Insertion of a nasogastric (NG) tube to suction to decompress the stomach In treating the patient with pyloric obstruction, the first consideration is to insert an NG tube to decompress the stomach. Nutrition is not an immediate priority, and neither gastric lavage nor cleansing enemas is indicated.

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. A. Provide omeprazole as prescribed. B. Review actions to reduce stress. C. Suggest using over the counter ibuprofen for pain control. D. Remind to avoid alcohol intake. E. Instruct to avoid foods that aggravate the condition.

A. Provide omeprazole as prescribed. B. Review actions to reduce stress. D. Remind to avoid alcohol intake. E. Instruct to avoid foods that aggravate the condition. Chronic gastritis is managed by recommending avoidance of alcohol, reducing stress, providing medications to include proton pump inhibitors, and modifying the diet by avoiding foods that aggravate the condition. Over-the-counter NSAIDs should be avoided as this can aggravate the condition.

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: A. Frequency of abdominal discomfort. B. Immediacy of the occurrence. C. Presence of vomiting. D. Incidence of anorexia.

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

A nurse is preparing a presentation for a local community group about peptic ulcer disease and the two major types. When comparing the potential risk factors associated with duodenal and gastric ulcers, which factor would the nurse include as being associated with both types? Select all that apply. A. cirrhosis B. cigarette smoking C. Helicobacter pylori (H. pylori) infection D. alcohol use E. NSAID use

B. cigarette smoking C. Helicobacter pylori (H. pylori) infection D. alcohol use Risk factors associated with both duodenal and gastric ulcers include H. pylori infection, alcohol use and cigarette smoking. NSAID use is a risk factor for gastric ulcers. Cirrhosis is a risk factor for duodenal ulcers.

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? A. Hypotension and tachycardia B. Bradypnea and pursed lip breathing C. Peripheral and pulmonary edema D. Restlessness and cyanosis

A. Hypotension and tachycardia Rebleeding has multiple manifestations. However, an increase in heart rate and decrease in blood pressure are key signs of a hemorrhage that are present in nearly all patients who are experiencing rebleeding.

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

D. 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.

A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply. A. Tachycardia B. Mild epigastric pain C. Hypotension D. A rigid, board-like abdomen E. Diarrhea

A. Tachycardia C. Hypotension D. 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 of the following appears to be a significant factor in the development of gastric cancer? A. Diet B. Age C. Ethnicity D. Gender

A. 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 European Americans to develop gastric cancer.

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. Previous infection with H. pylori B. Age 55 years C. Female gender D. European ancestry E. High intake of fruits and vegetables

A. Previous infection with H. pylori B. Age 55 years 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.

A client is recovering from gastric surgery. What is the correct position for the nurse to place this client? A. Trendelenburg B. Fowler's C. Supine D. Semi-Fowler's

B. Fowler's Placing the client in the Fowler's position after gastric surgery promotes comfort and allows emptying of the stomach.

A client recovering from surgery for gastric cancer develops dumping syndrome. Which teachings will the nurse provide to reduce the symptoms of this condition? Select all that apply. A. Drink fluids with meals. B. Ingest 6 small meals a day. C. Eat foods low in carbohydrates. D. Select foods high in sugar. E. Remain upright after meals.

B. Ingest 6 small meals a day. C. Eat foods low in carbohydrates. Management of dumping syndrome includes encouraging 6 small feedings daily that are low in carbohydrates and sugar and the consumption of fluids between meals rather than with meals. There is no evidence to support that the client should remain in the upright position after meals to prevent 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: A. fluid intake to 1 qt (1,000 ml)/day. B. drink liquids only with meals. C. don't drink liquids 2 hours before meals. D. drink liquids only between meals.

D. drink liquids only between meals. 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 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. Hepatomegaly B. Ascites C. Sister Mary Joseph's nodules D. Distended bladder E. Petechiae at the palpation site

A. Hepatomegaly B. Ascites 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.

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 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 a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply. A. Esomeprazole B. Famotidine C. Cimetidine D. Nizatidine E. Lansoprazole

B. Famotidine C. Cimetidine D. Nizatidine H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton-pump inhibitors.

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. Works best when taken on an empty stomach B. Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) C. Increases the speed of gastric emptying D. Decreases mucus production

B. Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) (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 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 To determine the client's weight in kg, divide the weight in lb. by 2.2 or 165 / 2.2 = 75 kg. Fluid balance for this client would be 75 mL/hr. For four hours, the client's output would need to be 300 mL as an indication of fluid balance.

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. A. Belching B. Sour taste in the mouth C. Hiccups D. Early satiety E. Hematemesis

A. Belching B. Sour taste in the mouth D. Early satiety Clinical manifestations of chronic gastritis include belching, early satiety, and a sour taste in the mouth. Hiccups and hematemesis are symptoms of acute gastritis.

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? A. Small amounts of blood-tinged output B. Moderate amounts of clear output C. Copious quantities of straw-colored output D. Scant amounts of greenish-colored output

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

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

A client is demonstrating symptoms of a tumor in the small bowel. About which diagnostic test will the nurse anticipate teaching the client? A. Abdominal flat plate x-ray B. Barium enema C. Upper GI series with small bowel follow-through D. Ultrasound of the abdomen

C. Upper GI series with small bowel follow-through An upper GI x-ray series with small bowel follow-through using oral water-insoluble contrast with frequent and detailed x-rays to follow the contrast through the small bowel is the traditional approach to diagnose tumors in the small bowel. A barium enema, ultrasound of the abdomen, or abdominal flat plate x-ray are not used to diagnose tumors of the small bowel.

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. 25% B. Greater than 50% C. Less than 5% D. 15%

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

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. 250 mL B. 350 mL C. 150 mL D. 450 mL

D. 450 mL A residual of greater than 400 mL strongly suggests obstruction.

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 A. nizatidine (Axid) B. omeprazole (Prilosec) C. vasopressin (Pitressin) D. octreotide (Sandostatin)

D. 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.

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? A. Suppressing emesis B. Drinking milk C. Eating D. Having a bowel movement

C. Eating Taking antacids, eating, or vomiting often relieves the pain. Pain occurs about 2 hours after eating. Milk is contraindicated in relieving peptic ulcer pain.

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? A. "I remember my father often complaining about heartburn and indigestion." B. "My endocrinologist recently increased my dose of metformin that I take for my diabetes." C. "I've been taking glucosamine supplements because I've been told they'll help my arthritis." D. "I've changed from taking Tylenol for my arthritis pain to taking aspirin."

D. "I've changed from taking Tylenol for my arthritis pain to taking aspirin." Overuse of aspirin is frequently implicated in cases of acute gastritis. Family history and the use of glucosamine and metformin are not common contributors to acute gastritis.

Which ulcer is associated with extensive burn injury? A. Peptic ulcer B. Cushing ulcer C. Duodenal ulcer D. Curling ulcer

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

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 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.

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. Pernicious anemia B. Systemic infection C. Peptic ulcers D. Colostomy

C. Peptic ulcers 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 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. Nizatidine B. Cimetidine C. Famotidine D. Omeprazole

D. Omeprazole 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 58-year-old man who leads a busy lifestyle managing his own business has been diagnosed with a gastric ulcer. The man has told the nurse, "My wife warned me that my job stress would eventually catch up with me!" How should the nurse best respond to the patient's statement? A. "Actually, it's been found that stress doesn't really cause ulcers." B. "Ulcers aren't caused by anything specific; some people develop them for no particular reason." C. "Researchers have found that your environment is the most significant cause of ulcers." D. "Most ulcers are a consequence of the different medications that you take."

A. "Actually, it's been found that stress doesn't really cause ulcers." In the past, stress and anxiety were thought to be causes of ulcers, but research has documented that peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water. Medications can cause ulcers, but this is not the case for all patients. Aspects of the environment have not been specifically linked to the development of ulcers.

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? A. Can cause constipation B. May cause diarrhea and cramping C. Needs to be taken without food D. Awaiting the results of a pregnancy test

D. Awaiting the results of a pregnancy test

A client is newly diagnosed with a peptic ulcer. For which medications will the nurse prepare teaching for this client? Select all that apply. A. Bismuth subsalicylate B. Metronidazole C. Omeprazole D. Diphenhydramine E. Warfarin

A. Bismuth subsalicylate B. Metronidazole C. Omeprazole In the past, stress and anxiety were thought to be causes of peptic ulcers, but research has documented that most peptic ulcers result from infection with H. pylori, which may be acquired through ingestion of food and water. Because of this, antibiotics such as metronidazole are used to treat peptic ulcers. Bismuth salts, such as bismuth subsalicylate, potentiate the effects of an antibiotic and also have antacid properties. Proton pump inhibitors, such as omeprazole, reduce the amount of hydrochloric acid produced by stomach cells. Anticoagulants, such as warfarin, and antihistamines, diphenhydramine, are not used to treat peptic ulcer disease.

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

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

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. Curling's ulcer B. Peptic ulcer C. Esophageal ulcer D. Meckel's ulcer

A. 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. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.

Which medication classification represents a proton (gastric acid) pump inhibitor? A. Omeprazole B. Sucralfate C. Famotidine D. Metronidazole

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

D. "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 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? A. 32 kg/m2 B. 34 kg/m2 C. 30kg/m2 D. 36 kg/m2

D. 36 kg/m2 To meet the criteria for bariatric surgery, the client must have a BMI of at least 35 kg/m2 with obesity-associated comorbidity (e.g., severe sleep apnea, hypertension, cardiomyopathy related to obesity, severe diabetes mellitus, and serious musculoskeletal or neurologic disorders).

After assessing a client with peptic ulcer disease, the nurse notifies the health care provider because the nurse suspects that the client may be experiencing perforation. Which assessment finding would support the nurse's suspicion? Select all that apply. A. severe upper abdominal pain B. constipation C. vomiting D. board-like abdomen E. hypertension

A. severe upper abdominal pain C. vomiting D. board-like abdomen Signs and symptoms of perforation include sudden, severe upper abdominal pain (persisting and increasing in intensity); pain that 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, which indicate shock.

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

D. 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.

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? A. Ask dietary for a full liquid tray. B. Maintain nothing by mouth status. C. Call for a regular diet meal tray. D. Provide ice chips.

D. Provide ice chips. For acute gastritis, the client should take no foods or fluids by mouth until the acute symptoms subside. After symptoms subside and the client reports feeling hungry, ice chips should be provided before offering full liquids. Introduce solid food as soon as possible while minimizing irritation to the gastric mucosa; however, ice chips should be provided first. Maintaining nothing by mouth status may cause additional gastric irritation.

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. a sedentary lifestyle and smoking. C. alcohol abuse and a history of acute renal failure. D. alcohol abuse and smoking.

D. 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 newly diagnosed with stomach cancer. The nurse will plan to provide the client education on which treatment? A. Surgery B. Intermittent monitoring C. Chemotherapy D. Radiation

A. Surgery Surgery is more hazardous for the older adult, and the risk increases proportionately with increasing age. Nonetheless, gastric cancer should be treated with surgery in older patients. Other treatments such as radiation and chemotherapy will be decided after surgery. Intermittent monitoring is not a treatment option for gastric cancer in the older adult

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

B. 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 client is diagnosed with peptic ulcer disease secondary to NSAID use. When preparing this client's plan of care, which medication would the nurse anticipate being prescribed? Select all that apply. A. ampicillin B. famotidine C. omeprazole D. sucralfate E. bismuth

B. famotidine C. omeprazole Histamine-2 (H2) receptor antagonists (H2 blockers), such as famotidine, and proton pump inhibitors (PPIs), such as omeprazole, are used to treat NSAID-induced ulcers and other ulcers not associated with H. pylori infection. The other drugs listed would be used as part of a regimen when H. pylori is involved.

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? A. hematemesis B. melena C. pyrosis D. achlorhydria

B. melena Melena is the term used to denote black, tarry stools. Hematemesis refers to blood in vomit. Pyrosis is a burning sensation in the esophagus and stomach that moves up to the mouth. Achlorhydria refers to an absence of hydrochloric acid in the stomach.

A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make? A. "It aids in the healing of the stomach lining." B. "It improves digestion in the stomach." C. "It enhances the function of the pyloric sphincter." D. "It helps propel food from the stomach into the duodenum."

A. "It aids in the healing of the stomach lining." Bismuth subsalicylate suppresses H. pylori bacteria in the gastric mucosa and assists with healing of mucosal ulcers. It does not affect digestion, enhance the function of the pyloric sphincter, or propel food from the stomach into the duodenum.

A client with gastric cancer is planning to receive chemotherapy. Which medication will be used as the primary agent to improve the tumor response rate? A. Paclitaxel B. Docetaxel C. Carboplatin D. Fluorouracil

D. Fluorouracil In instances where the gastric tumor is not resectable, treatment with chemotherapy may offer further control of the disease or palliation. Chemotherapy may also be used in addition to surgery as adjuvant treatment of gastric cancer. For improved tumor response rates, it is more common to administer combination chemotherapy, primarily fluorouracil-based therapy, with other agents. Paclitaxel, docetaxel, and carboplatin are chemotherapeutic agents used to treat gastric cancer, however, are not used in combination in order to improve tumor response rates.

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? A. "Have you ever been diagnosed with reflux?" B. "Do you consider yourself to have a healthy diet?" C. "Have you been prone to infections over the past few years?" D. "Do you ever find it difficult to swallow certain foods?"

A. "Have you ever been diagnosed with reflux?" Gastroesophageal reflux disease (GERD) is a significant risk factor for peptic ulcer disease. Poor diet, general infections, and dysphagia are less closely associated with etiology of esophageal ulcers.

A client with recurrent peptic ulcer disease asks, "How long do I have to take the medication?" Which response will the nurse make? A. "Prophylactically for now." B. "One month or so." C. "For the rest of your life." D. "Until the prescription is gone."

A. "Prophylactically for now. "Recurrence of peptic ulcer disease within 1 year may be prevented with the prophylactic use of H2 blockers taken at a reduced dose. Not all clients require maintenance therapy; it may be prescribed only for those with two or three recurrences per year, those who have had a complication such as bleeding or gastric outlet obstruction, or those for whom gastric surgery poses too high a risk. The likelihood of recurrence is reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, alcohol, and ulcerogenic medications such as NSAIDs. The response "it depends on if the ulcer recurs" is the most accurate. There is no way of knowing if the client will need to take the medication for a month or two or the rest of the client's life. The health care provider will determine the length of time the medication will need to be taken after all doses in the current prescription are taken.

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. "You may have ingested some irritating foods." B. "It is probably your nerves." C. "It is a hereditary disease." D. "Is it possible that you are overusing aspirin." E. "It can be caused by ingestion of strong acids."

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

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. A decrease in HCl production by parietal cells B. Activation of the gastric buffer system and release of alkaline gastric secretions C. An increase in the pH of gastric secretions D. The occlusion of parietal cells

A. A decrease in HCl production by parietal cells Histamine-2 receptor antagonists decrease the amount of HCl produced by stomach by blocking action of histamine on histamine receptors of parietal cells in the stomach. They do not directly increase the pH of gastric secretions, and they do not activate a buffer system or occlude parietal cells.

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? A. Correcting nutritional deficits B. Preventing deep vein thrombosis (DVT) C. Teaching about radiation treatment D. Discharge planning

A. Correcting nutritional deficits Clients with gastric cancer commonly have nutritional deficits and may have cachexia. Therefore, correcting nutritional deficits is a top priority. Discharge planning before surgery is important, but correcting the nutritional deficits is a higher priority. Radiation therapy hasn't been proven effective for gastric cancer, and teaching about it preoperatively wouldn't be appropriate. Preventing DVT isn't a high priority before surgery, but it assumes greater importance after surgery.

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? A. Dumping syndrome B. Celiac disease C. Bile reflux D. Gastric outlet obstruction

A. 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).

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. Duodenum B. Stomach C. Esophagus D. Pylorus

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

Which of the following is the most common complication associated with peptic ulcer? A. Elevated temperature B. Hemorrhage C. Vomiting D. Abdominal pain

B. Hemorrhage 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.

The nurse is doing triage at the emergency department when a middle-aged patient presents with abdominal pain and heartburn. The patient states the symptoms have persisted for several days following a particularly spicy meal. When assessing the patient, the nurse notes the patient has a history of acute gastritis. What complication should the nurse assess for? A. Esophageal or pyloric obstruction related to scarring B. Bruising on the patient's flanks C. Gastric hyperacidity related to excessive gastrin secretion D. Acute systemic infection related to peritonitis

A. Esophageal or pyloric obstruction related to scarring Acute gastritis can result from dietary indiscretion, and may lead to scarring and stenosis, often requiring dilation. Acute systemic infection occurs following perforation. Perforation is not a common occurrence following ingestion of a corrosive substance. Gastrin is a hormone secreted in the stomach. It is not normally found in the esophagus. Peptic ulcer disease does not cause bruising.

The nurse is caring for a client experiencing unintentional weight loss and occasional abdominal pain. Which additional symptoms will the nurse expect to assess if the client has a tumor In the small intestine? Select all that apply. A. Fatigue B. Weakness C. Vomiting D. Jaundice E. Nausea

A. Fatigue B. Weakness C. Vomiting E. Nausea Tumors of the small intestine often present insidiously with vague, nonspecific symptoms. Most clients have sustained weight loss and may be malnourished at the time of diagnosis. Reports of pain are common. The client also frequently presents with fatigue, nausea, vomiting, and weakness. Jaundice is not a symptom of a tumor in the small intestine.

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. Bradycardia C. Hypertension D. Polyuria

A. 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.

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. Hemorrhage B. Intractable ulcer C. Pyloric obstruction D. Perforation

A. 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.

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: A. Iron and vitamin B12 B. Prealbumin and bilirubin C. Ionized calcium and C-reactive protein D. Creatinine and blood urea nitrogen (BUN)

A. Iron and vitamin B12 Dietary deficiencies associated with gastrectomy include malabsorption of organic iron, which may require supplementation with oral or parenteral iron, and a low serum level of vitamin B12, which may require supplementation by the intramuscular route. The other given blood values are not directly affected by gastrectomy.

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? A. Notify the primary health care provider. B. Provide a dose of a proton pump inhibitor. C. Encourage the client to drink a warm beverage. D. Discuss the types of foods the client has been eating.

A. 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.

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. A. Observing stools and vomitus for color, consistency, and volume B. Checking the blood pressure and pulse rate every 15 to 20 minutes C. Making neurovascular checks every 4 hours D. Inserting an indwelling catheter for incontinence E. Frequently monitoring hemoglobin and hematocrit levels

A. Observing stools and vomitus for color, consistency, and volume B. Checking the blood pressure and pulse rate every 15 to 20 minutes E. 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).

A nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The health care provider has ordered the "triple therapy" regimen. Which medications will the nurse educate the client on? A. Proton-pump inhibitor and two antibiotics B. H2-receptor antagonist and two antibiotics C. H2-receptor antagonist, proton-pump inhibitor, and an antibiotic D. Proton-pump inhibitor, an antibiotic, and bismuth salts

A. Proton-pump inhibitor and two antibiotics 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 bacteria. 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.

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? A. The medication is to be swallowed whole and taken before meals B. Abdominal pain and abnormal liver function tests are expected effects C. May cause diarrhea and hyperglycemia D. Interferes with the metabolism of digoxin, iron, and warfarin

A. 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.

The nurse is teaching a client diagnosed with peptic ulcer disease about how to make the necessary dietary changes to decrease acid secretion. The client demonstrates understanding of the information by identifying the need to avoid which substance? Select all that apply. A. milk products B. decaffeinated coffee C. carbonated water D. creamy sauces E. water

A. milk products B. decaffeinated coffee D. creamy sauces The intent of dietary modification for clients with peptic ulcers is to avoid oversecretion of acid and hypermotility in the GI tract. These can be minimized by avoiding extremes of temperature in foods and beverages as well as overstimulation from consumption of meat extracts, alcohol, coffee (including decaffeinated coffee, which also stimulates acid secretion) and other caffeinated beverages, and diets rich in milk and cream (which stimulate acid secretion).

A client is admitted to the hospital with an exacerbation of chronic gastritis. When assessing the client's nutritional status, the nurse should expect to find what type of deficiency? A. vitamin B12 B. vitamin C C. vitamin A D. vitamin B6

A. vitamin B12 The nurse should expect vitamin B12 deficiency. Injury to the gastric mucosa causes gastric atrophy and impaired function of the parietal cells. These changes result in reduced production of intrinsic factor, which is necessary for the absorption of vitamin B12. Eventually, pernicious anemia will occur. Deficiencies in vitamins A, B6, and C aren't expected in a client with chronic gastritis.

The nurse is preparing to visit the home of a client recovering from gastritis. Which information will the nurse prepare to instruct this client? Select all that apply. A. Adhering with the prescribed medication regimen B. Identification of foods and substances that cause the condition C. Time when all medications can be safely stopped D. Methods to remember to take medication as prescribed E. Findings that should be reported to the health care provider

Adhering with the prescribed medication regimen B. Identification of foods and substances that cause the condition D. Methods to remember to take medication as prescribed E. Findings that should be reported to the health care provider When teaching a client with gastritis, the nurse should include information about the use of reminders to take medications. The nurse should also emphasize the importance of adhering to the prescribed medication regimen. The client should be able to list findings that should be reported to the health care provider and should be able to identify foods and substances to avoid because they cause or aggravate the condition. The nurse will not discuss when the medications can be safely stopped as this is determined by the health care provider.

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

B. "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 client recovering from the removal of a gastric tumor asks why radiation therapy is needed. Which response will the nurse provide? A. "It is to prevent the development of a wound infection." B. "It is to kill any remaining cancer cells." C. "It is to reduce your need for medication." D. "It is to heal the wound faster."

B. "It is to kill any remaining cancer cells." Radiation therapy may also be used alone or along with chemotherapy before surgery to decrease the size of the tumor, or after surgery to destroy any remaining cancer cells and to delay or prevent reoccurrence of the cancer. Radiation therapy is not used to heal the surgical wound, reduce the need for medication, or to prevent the development of a wound infection.

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? A. Insight into why their past weight loss efforts failed B. Emotional stability and understanding of required lifestyle changes. C. Knowledge of the causes of obesity and its associated risks D. body image and high self-esteem

B. Emotional stability and understanding of required lifestyle changes. Patients seeking bariatric surgery must be evaluated by a psychiatrist, psychologist, or advanced practice mental health nurse to establish that they are free of serious mental disorders and are motivated to comply with lifestyle changes related to eating patterns, dietary choices, and elimination. Obese patients are often unlikely to have a positive body image due to the social stigma associated with obesity. While assessment of knowledge about causes of obesity and its associated risks, as well as insight into the reasons why previous diets have been ineffective are included in the patient's plan of care, these do not predict positive patient outcomes following bariatric surgery. Most obese patients have an impaired body image and alteration in self-esteem. An obese patient with a positive body image would be unlikely to seek this surgery unless she or he was experiencing significant comorbidities.

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. Notify the health care provider that the client is eager to sign the consent form. B. Evaluate the client's understanding of the procedure. C. Ask the client about his or her plans for after surgery. D. Rejoice with the client.

B. Evaluate the client's understanding of the procedure. 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.

Which medication is classified as a histamine-2 receptor antagonist? A. Lansoprazole B. Famotidine C. Esomeprazole D. Metronidazole

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

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. A. Inform the client the medication will solve the problem. B. Interact with the client in a relaxed manner. C. Help identify the client's current stressors. D. Offer information about relaxation methods. E. Discuss potential coping techniques with the client.

B. Interact with the client in a relaxed manner. C. Help identify the client's current stressors. D. Offer information about relaxation methods. E. Discuss potential coping techniques with the client. A client with a peptic ulcer may have a problem with anxiety. To help reduce the client's anxiety, the nurse should interact with the client in a relaxed manner and help the client identify stressors. The nurse can also discuss potential coping techniques and offer information about relaxation methods. Stating that medication will solve the problem may not be sufficient if stress and anxiety are contributors to the development of the ulcer.

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? A. The cardiac sphincter is unable to dilate quickly after bariatric surgery. B. Nausea and esophageal distention can result from eating too fast. C. Eating too quickly can cause gastric ulceration. D. Eating quickly is associated with weight gain.

B. Nausea and esophageal distention can result from eating too fast. Because of the physical alterations to the upper gastrointestinal (GI) tract that are created during bariatric surgery, the patient is prone to nausea and esophageal distention if he or she eats too quickly. Eating quickly does not contribute to ulceration or weight gain following surgery. The cardiac sphincter is not modified during bariatric surgery.

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 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. Constipation D. Extreme gastric hyperacidity E. Gastrin-secreting tumors of the pancreas

B. Severe peptic ulcers D. Extreme gastric hyperacidity E. 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 nurse at a long-term care facility is conducting an intake assessment and health history with a new female resident and the resident's daughter. The daughter states that her mother had a Billroth II gastrectomy performed several years ago, a fact that must be accommodated into her care. The nurse would be justified in questioning the resident about her history of: A. Peptic ulcer disease B. Stomach cancer C. Gastroesophageal reflux disease (GERD) D. Pyloric stenosis

B. Stomach cancer Gastrectomies such as the Billroth II are performed to treat gastric cancer, not GERD, pyloric stenosis or peptic ulcers.

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 proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori. B. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. C. The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. D. The antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori.

B. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. 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.

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? A. May cause diarrhea and hyperglycemia B. The medication is to be swallowed whole and taken before meals C. Abdominal pain and abnormal liver function tests are expected effects D. Interferes with the metabolism of digoxin, iron, and warfarin

B. 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 with gastric ulcers caused by H. pylori is prescribed metronidazole. Which client statement indicates to the nurse that teaching about this medication was effective? A. "I can take this medication with my blood thinner." B. "My appetite may increase while taking this medication." C. "It might cause a metallic taste in my mouth." D. "I can have an alcoholic drink in the evenings.

C. "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.

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? A. 2.5 L B. 1.0 L C. 1.5 L D. 2.0 L

C. 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).

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 cancer B. Gastric ulcer C. Acute gastritis D. Duodenal ulcer

C. 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 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. Pyloroplasty B. Billroth II C. Billroth I D. Vagotomy

C. Billroth I 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.

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. Coffee-ground-like B. Clay-colored C. Black and tarry D. Bright red

C. 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.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 patient asks the home health nurse from what the distressing symptoms of dumping syndrome result. What physiological occurrence should the nurse explain? A. Irritation of the phrenic nerve due to diaphragmatic pressure B. Reflux of bile into the distal esophagus C. Osmotic transport of extracellular fluid into the gastrointestinal tract D. Chronic malabsorption of iron and vitamins A and C

C. Osmotic transport of extracellular fluid into the gastrointestinal tract Following gastric surgery, the gastric remnant is anastomosed to the jejunum. When substances high in carbohydrates and electrolytes are ingested rapidly, they pass directly into the jejunum. Extracellular fluid from the bloodstream is drawn into the jejunum to dilute these hypertonic intestinal contents. Irritation of the phrenic nerve causes hiccups. Reflux of bile is an etiologic factor associated with the development of gastroesophageal reflux disease (GERD). Patients who have undergone partial gastrectomy or bariatric surgery may absorb vitamins and minerals less effectively; however, this change is unrelated to the occurrence of dumping syndrome.

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. Allows for better absorption of vitamin B12 B. Provides much needed rest C. Slows gastric emptying D. Removes tension on internal suture line

C. 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 client recovering from surgery to resect a gastric tumor reports abdominal cramping and diarrhea after eating. Which additional symptoms will the nurse use to determine if the client is experiencing dumping syndrome? Select all that apply. A. Increased desire to consume foods that are dairy products B. Inability to tolerate foods with animal fat C. Sudden onset of extreme shakiness and fatigue D. Audible bowel sounds and pain radiating to the back E. Report of extreme hunger 3 hours after eating

C. Sudden onset of extreme shakiness and fatigue E. Report of extreme hunger 3 hours after eating Dumping syndrome may occur as a result of any surgical procedure that involves the removal of a significant portion of the stomach. Early symptoms tend to occur within 10 to 30 minutes after a meal and often include early satiety, cramping abdominal pain, nausea, vomiting, and diarrhea. Later, the rapid elevation in blood glucose is followed by the increased secretion of insulin, which results in hypoglycemia 2 to 3 hours after eating. Manifestations of hypoglycemia may include extreme hunger, shakiness, and fatigue. Findings associated with dumping syndrome do not include an intolerance of foods with animal fat, audible bowel sounds with pain radiating to the back, or a desire to consume dairy products.

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? A. Proximal subtotal gastrectomy B. Limited resection in the distal portion of the stomach and removal of about 25% of the stomach C. Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach D. Total gastrectomy and esophagogastrectomy

C. 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.

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

D. "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 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? A. "I felt better but then just got really nauseated and threw up." B. "I only ate dinner yesterday and it gave me an upset stomach." C. "I think the soda that I drank irritated my stomach." D. "The pain stopped so I stopped taking the medications."

D. "The pain stopped so I stopped taking the medications." The client should be instructed to adhere to and complete the medication regimen to ensure complete healing of the peptic ulcer. Because most clients become symptom free within a week, it should be stressed to the client the importance of following the prescribed regimen so that the healing process can continue uninterrupted and the return of symptoms can be prevented. Since the client stopped taking the medication, the ulcer was not healed and became worse. The statements about soda, being nauseated, and eating only one meal would not explain the reason for the client's new onset of hematemesis during treatment for a peptic ulcer.

A client with chronic peptic ulcers is considering a vagotomy. Which information will the nurse provide to the client about this surgical procedure? A. The lower part of the stomach is attached to the duodenum. B. It widens the pylorus to allow increased stomach emptying. C. It can cause anemia, weight loss, and malabsorption. D. Adverse effects such as dumping syndrome and gastritis can occur.

D. Adverse effects such as dumping syndrome and gastritis can occur. A vagotomy is the severing of the vagus nerve to make the cells in the stomach less responsive to gastrin. Adverse effects of this procedure include dumping syndrome and gastritis. A pyloroplasty enlarges the pylorus. The Billroth II procedure can cause anemia, weight loss, and malabsorption. A Billroth I procedure attaches the stomach to the duodenum.

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. Gastric secretion study B. Stool antigen test C. Barium study of the upper gastrointestinal tract D. Endoscopy

D. D. 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 term refers to the first portion of the small intestine? A. Pylorus B. Omentum C. Peritoneum D. Duodenum

D. Duodenum The duodenum is the first portion of the small intestine, between the stomach and the jejunum. The pylorus is the opening between the stomach and duodenum. The peritoneum is the thin membrane that lines the inside the wall of the abdomen and covers all the abdominal organs. The omentum is the fold of the peritoneum that surrounds the stomach and other organs of the abdomen.

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

D. Famotidine will 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. 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.

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? A. Antidepressants B. Multivitamin supplements C. Control-top panty hose D. Pregnancy

D. Pregnancy Women of childbearing age who have had bariatric surgery should avoid pregnancy for approximately 2 years until their weight stabilizes, and it is evident that their nutritional needs are being adequately met. Multivitamins are generally recommended for the patient to supplement dietary sources of nutrients. Antidepressants may be taken if clinically indicated. Control-top pantyhose may be uncomfortable postoperatively; however, they are not contraindicated.

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

D. 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.