Chapter 46: Management of Patients With Gastric and Duodenal Disorders Prep-U

Which of the following clients is at highest risk for peptic ulcer disease? Client with blood type A Client with blood type O Client with blood type B Client with blood type AB

Client with blood type O Explanation: Clients with blood type O are more susceptible to peptic ulcers than those with blood types A, B, and AB.

Which medication is classified as a histamine-2 receptor antagonist? Famotidine Esomeprazole Lansoprazole Metronidazole

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

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 Explanation: 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 teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol? Decreases mucus production Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Works best when taken on an empty stomach Increases the speed of gastric emptying

Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Misoprostol (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.

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

Refrain from food until the GI symptoms subside. Explanation: 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.

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

alcohol abuse and smoking. Explanation: 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.

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

pain 2 to 3 hours after a meal. Explanation: 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.

A young adult client is prescribed misoprostol to prevent gastric ulcers caused by frequent use of nonsteroidal anti-inflammatory agents for an autoimmune disorder. For which reason will the nurse question giving the client a dose of this medication? Awaiting the results of a pregnancy test Needs to be taken without food May cause diarrhea and cramping Can cause constipation

Awaiting the results of a pregnancy test Explanation: 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.

A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? "Be sure to wear sunscreen while taking this medicine." "Take the medication with milk." "You will not experience GI upset while taking this medication." "Do not drive when taking this medication."

"Be sure to wear sunscreen while taking this medicine." Explanation: Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. GI upset is possible with tetracycline administration. Administration of tetracycline does not necessitate driving restrictions.

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

"I will have to take vitamin B12 shots up to 1 year after surgery." Explanation: 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 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 Acute gastritis Gastric cancer Gastric ulcer

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

Amount of hydrochloric acid (HCL) secretion in the stomach Explanation: 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 client has been taking famotidine at home. What teaching should the nurse include with the client? Famotidine will inhibit gastric acid secretions. Famotidine will neutralize acid in the stomach. Famotidine will shorten the time required for digestion in the stomach. Famotidine will improve the mixing of foods and gastric secretions.

Famotidine will inhibit gastric acid secretions. Explanation: 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 cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: Perforation Hemorrhage Pyloric obstruction Intractable ulcer

Hemorrhage Explanation: 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.

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

Medications placed in a pillbox Explanation: The client with acute gastritis should be instructed on methods of keeping track of medications such as placing the doses into a pillbox. The client should also be instructed about foods and substances that may cause gastritis, including nicotine, spicy seasoned foods, and caffeine. Cigarettes in the ashtray, tomato sauce, and caffeinated coffee indicate that additional teaching is required.

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

Notify the primary health care provider. Explanation: 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.

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

Omeprazole Explanation: 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 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? Gastric penetration Ineffective treatment for the peptic ulcer A reaction to the medication given for the ulcer Perforation of the peptic ulcer

Perforation of the peptic ulcer Explanation: Signs and symptoms of perforation include the following: Sudden, severe upper abdominal pain (persisting and increasing in intensity), 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.

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 Coffee-ground-like Black and tarry Bright red

Black and tarry Explanation: 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 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? Esophageal ulcer Meckel's ulcer Peptic ulcer Curling's ulcer

Curling's ulcer Explanation: 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.

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. Cimetidine Omeprazole Nizatidine Famotidine

Omeprazole Explanation: 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.

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

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

"It aids in the healing of the stomach lining." Explanation: 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.

Which ulcer is associated with extensive burn injury? Peptic ulcer Duodenal ulcer Curling ulcer Cushing ulcer

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

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

Diet Explanation: 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.

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

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

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

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

10 to 14 days Explanation: 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).

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 Duodenum Esophagus Pylorus

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

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

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

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

"It might cause a metallic taste in my mouth." Explanation: 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.

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

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

A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal? Slows gastric emptying Provides much needed rest Removes tension on internal suture line Allows for better absorption of vitamin B12

Slows gastric emptying Explanation: 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.

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? Polyuria Hypertension Bradycardia Hematemesis

Hematemesis Explanation: 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.

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

Removal of the tumor Explanation: There is no successful treatment for gastric carcinoma except removal of the tumor. If the tumor can be removed while it is still localized to the stomach, the patient may be cured. If the tumor has spread beyond the area that can be excised, cure is less likely.

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? Penetration Perforation Hemorrhage Pyloric obstruction

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

Nizatidine Famotidine Cimetidine Explanation: 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.

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

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. Explanation: The nurse should use a calm approach when answering questions and providing teaching. He or she should discuss smoking cessation and monitor for any indicators of hemorrhagic gastritis. The client will take nothing by mouth for up to a few days until symptoms subside. The nurse needs to develop an individualized teaching plan for the client that includes information about stress management, diet, and medications.

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

300 Explanation: 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 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 Explanation: 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.

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 Discharge planning Preventing deep vein thrombosis (DVT) Teaching about radiation treatment

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

drink liquids only between meals. Explanation: 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 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 felt better but then just got really nauseated and threw up." "I think the soda that I drank irritated my stomach." "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." Explanation: 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 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. Petechiae at the palpation site Distended bladder Hepatomegaly Sister Mary Joseph's nodules Ascites

Ascites Hepatomegaly Explanation: 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 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 stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." "Caffeine increases the fluid volume in your system, which irritates your digestive organs."

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

The nurse instructs a client with acute gastritis on lifestyle modifications. Which client statement indicates that additional teaching is required? "I will reduce the amount of smoking." "I will switch to decaffeinated coffee." "I will increase my intake of fresh fruit." "I will avoid alcoholic beverages."

"I will reduce the amount of smoking." Explanation: Lifestyle modifications for the client with acute gastritis focus on smoking, alcohol intake, and caffeine. Smoking should be discouraged because the level of nicotine in gastric acid can be 10 times greater than in arterial blood and 80 times greater than venous blood. Alcohol intake should also be discouraged. Caffeinated beverages should also be discouraged because caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Increasing the intake of fresh fruit is not identified as a lifestyle modification for acute gastritis.

A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? "My ulcer will heal because these medications will kill the bacteria." "I should take these medications only when I have pain from my ulcer." "These medications will coat the ulcer and decrease the acid production in my stomach." "The medications will kill the bacteria and stop the acid production."

"The medications will kill the bacteria and stop the acid production." Explanation: 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. 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 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 Constipation Hemorrhage Awakening in pain

Awakening in pain Explanation: 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 reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included? Select all that apply. Avoid fruit drinks and soda. Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. Do not eat and drink at the same time. Limit meal size to 450 to 500 mL. Eat six meals a day.

Do not eat and drink at the same time. Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. Avoid fruit drinks and soda. Explanation: Total meal size should be restricted to less than 8 oz or 240 mL. Three meals a day are recommended.

A client who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the client reported cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the nurse educate the client about regarding this event? Dumping syndrome Bile reflux Celiac disease Gastric outlet obstruction

Dumping syndrome Explanation: Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery. Early symptoms include a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. These symptoms resolve once the intestine has been evacuated (i.e., with defecation).

A 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 Endoscopy Barium study of the upper gastrointestinal tract Gastric secretion study

Endoscopy Explanation: 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.

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? Paclitaxel Carboplatin Docetaxel Fluorouracil

Fluorouracil Explanation: 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.

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. Participation in highly competitive sports Irritating foods Ingestion of strong acids DASH diet Overuse of aspirin

Ingestion of strong acids Irritating foods Overuse of aspirin Explanation: 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.

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

Report of extreme hunger 3 hours after eating Sudden onset of extreme shakiness and fatigue Explanation: 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.

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

The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. Explanation: 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? May cause diarrhea and hyperglycemia Abdominal pain and abnormal liver function tests are expected effects Interferes with the metabolism of digoxin, iron, and warfarin The medication is to be swallowed whole and taken before meals

The medication is to be swallowed whole and taken before meals Explanation: 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 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? "I should limit alcohol intake, at least until symptoms subside." "I should feel better in about 24 to 36 hours." "My appetite should come back tomorrow." "Once I can eat again, I should stick with bland foods."

"My appetite should come back tomorrow." Explanation: 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.

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

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

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

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. Explanation: 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 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. Duodenum Bladder Pancreas Liver Lungs

Liver Pancreas Duodenum Explanation: Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.

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? H2-receptor antagonist and two antibiotics Proton-pump inhibitor, an antibiotic, and bismuth salts H2-receptor antagonist, proton-pump inhibitor, and an antibiotic Proton-pump inhibitor and two antibiotics

Proton-pump inhibitor and two antibiotics Explanation: 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.