Chapter 40 GI

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

"Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."

A client with peptic ulcer disease asks for pain medication. Which response will the nurse make? "Using pain medication is what caused the ulcer to develop." "I will ask the health care provider to prescribe pain medication." "The medications for the ulcer will reduce the pain." "Eating more food will help reduce the pain."

"The medications for the ulcer will reduce the pain."

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

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

"You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." "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.

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

10 to 14 days

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

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. The vagus nerve is cut and gastric drainage is established. A sectioned portion of the stomach is joined to the jejunum. The antral portion of the stomach is removed and a vagotomy is performed.

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 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? Duodenal ulcer Gastric cancer Gastric ulcer Acute gastritis

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.

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

Amount of hydrochloric acid (HCL) secretion in the stomach

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? Assess the client's abdomen and vital signs. Place the client in the high-Fowler's position. Irrigate the client's NG tube. Notify the health care provider.

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

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

Awaiting the results of a pregnancy test Misoprostol is a synthetic prostaglandin that protects the gastric mucosa from agents that cause ulcers, and also increases mucus production and bicarbonate levels. It is a pregnancy category X medication and should not be taken by a pregnant client as it can soften the cervix and result in miscarriage or premature labor. This medication does not cause constipation. Sucralfate needs to be taken without food. Misoprostol can cause diarrhea and cramping; however, this is not the reason to question giving the client a dose of the medication.

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

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

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? Clay-colored Bright red Coffee-ground-like Black and tarry

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.

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? Medication adverse effects Bleeding from the ulcer Evidence of ulcer healing Allergic response to the medication

Bleeding from the ulcer

The nurse is providing preoperative care for a client with gastric cancer who is having a resection. What is the nursing management priority for this client? Correcting nutritional deficits Teaching about radiation treatment Preventing deep vein thrombosis (DVT) Discharge planning

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 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? Meckel's ulcer Curling's ulcer Peptic ulcer Esophageal ulcer

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

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

Diet

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? Bile reflux Celiac disease Dumping syndrome Gastric outlet obstruction

Dumping syndrome

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

Duodenal ulcers

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

Duodenum

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

Endoscopy

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

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

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

Famotidine will inhibit gastric acid secretions.

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

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

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? Bradycardia Hematemesis Polyuria Hypertension

Hematemesis

A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed? Perforation Pyloric obstruction Hemorrhage Penetration

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

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

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.

The nurse visits the home of a client recovering from acute gastritis. Which observation indicates that teaching about the disorder was effective? Tomato sauce simmering on the stove Cup of caffeinated coffee on the kitchen table Medications placed in a pillbox Extinguished cigarettes in an ashtray

Medications placed in a pillbox

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

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

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

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

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

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

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. Provide a dose of a proton pump inhibitor. Encourage the client to drink a warm beverage. 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 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. Nizatidine Cimetidine Omeprazole Famotidine

Omeprazole

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

Omeprazole

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

Perforation of the peptic ulcer

A nurse is caring for a client who is suspected to have developed a peptic ulcer hemorrhage. Which action would the nurse perform first? Place the client in a recumbent position with the legs elevated. Prepare a peripheral and central line for intravenous infusion. Assess vital signs. Notify the healthcare provider.

Place the client in a recumbent position with the legs elevated. The treatment of hemorrhage includes complete rest for the GI tract, placing the client in a recumbent position with the legs elevated to increase blood flow to vital organs, blood transfusions, and gastric lavage with saline solution. Placing an IV, checking the client's vital signs, and notifying the healthcare provider are important, but not the priority action for the nurse when a client is actively bleeding.

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

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

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

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

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

Removal of the tumor

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

Six small meals daily with 120 mL fluid between meals

Which is the best rationale for the client being taught to lie down for 30 minutes after each meal? Slows gastric emptying Allows for better absorption of vitamin B12 Provides much needed rest Removes tension on internal suture line

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. Increased desire to consume foods that are dairy products Audible bowel sounds and pain radiating to the back Inability to tolerate foods with animal fat Sudden onset of extreme shakiness and fatigue Report of extreme hunger 3 hours after eating

Sudden onset of extreme shakiness and fatigue 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.

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

The medication is to be swallowed whole and taken before meals

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

Vasomotor symptoms associated with dumping syndrome

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

alcohol abuse and smoking.

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

drink liquids only with 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 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. Bladder Liver Lungs Pancreas Duodenum

liver, pancreas, duodenum

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

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.