Chapter 46: Management of Patients With Gastric and Duodenal Disorders

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

Answer: B.) Most clients are asymptomatic during the early stage of the disease.

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.) Three meals and three snacks and 120 mL fluid daily C.) Six small meals and 120 mL fluid daily D.) Six small meals daily with 120 mL fluid between meals

Answer: D.) Six small meals daily with 120 mL fluid between meals

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

Answer: D.) 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: A.) restrict 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.

Answer: D.) drink liquids only between meals.

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.) Increases the speed of gastric emptying C.) Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) D.) Decreases mucus production

Answer; C.) Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs)

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.) - "It can be caused by ingestion of strong acids." - "You may have ingested some irritating foods." - "Is it possible that you are overusing aspirin." - "It is a hereditary disease." - "It is probably your nerves."

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

Which of the following interventions are appropriate for clients with gastritis? Select all that apply. - Use a calm approach to reduce anxiety. - Give the client food and fluids every 4 hours. - Discourage cigarette smoking. - Notify the physician of indicators of hemorrhagic gastritis. - Provide general education about how to prevent recurrences.

Answer: - Use a calm approach to reduce anxiety. - Discourage cigarette smoking. - Notify the physician of indicators of hemorrhagic gastritis. - Provide general education about how to prevent recurrences.

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

Answer: A.) A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

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

Answer: A.) Diet

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

Answer: A.) Famotidine will inhibit gastric acid secretions. Rationale: 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.

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

Answer: A.) Hematemesis

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine. Before the client is discharged, the nurse should provide which instruction? A.) "Eat three balanced meals every day." B.) "Stop taking the drugs when your symptoms subside." C.) "Avoid aspirin and products that contain aspirin." D.) "Increase your intake of fluids containing caffeine."

Answer: C.) "Avoid aspirin and products that contain aspirin."

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

Answer: C.) 10 to 14 days

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? A.) Pelvic x-ray B.) Stool specimen C.) Nasogastric tube insertion D.) Oral contrast

Answer: C.) Nasogastric tube insertion Rationale: 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.

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

Answer: C.) Peptic ulcers

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

Answer: C.) pain 2 to 3 hours after a meal. Rationale; 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.

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? A.) Notify the health care provider. B.) Irrigate the client's NG tube. C.) Place the client in the high-Fowler's position. D.) Assess the client's abdomen and vital signs.

Answer: D.) Assess the client's abdomen and vital signs.

Review the following four examples of ideal body weight (IBW), actual weight, and body mass index (BMI). Using three criteria for each example, select the body weight that indicates morbid obesity. A.) IBW = 150 lbs; weight = 190 lbs; BMI = 26 kg/m2 B.) IBW = 132 lbs; weight = 184 lbs; BMI = 28 kg/m2 C.) IBW = 175 lbs; weight = 265 lbs; BMI = 29 kg/m2 D.) IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2

Answer: D.) IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2

Peptic ulcer disease occurs more frequently in people with which blood type? A.) A B.) B C.) AB D.) O

Answer: D.) O

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

Answer: - Nizatidine - Famotidine - Cimetidine

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

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

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

Answer: B.) Endoscopy

A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. Based on the client's assessment, what will the nurse suspect? A.) Dumping syndrome B.) Dehiscence of the surgical wound C.) Peritonitis D.) A normal reaction to surgery

Answer: A.) Dumping syndrome

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

Answer: A.) Famotidine

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

Answer: A.) Slows gastric emptying

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

Answer: D.) Omeprazole

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

Answer: A.) Omeprazole

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? A.) Hemorrhage B.) Penetration C.) Perforation D.) Pyloric obstruction

Answer: A.) Hemorrhage

Which of the following is the most successful treatment for gastric cancer? A.) Removal of the tumor B.) Chemotherapy C.) Radiation D.) Palliation

Answer: A.) Removal of the tumor

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

Answer: A.) Acute gastritis