Chapter 47: Management of Patients With Gastric and Duodenal Disorders

A client is prescribed tetracycline to treat peptic ulcer disease. Which of the following instructions would the nurse give the client? "Take the medication with milk." "Be sure to wear sunscreen while taking this medicine." "Expect a metallic taste when taking this medicine, which is normal." "Do not drive when taking this medication."

Correct response: "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. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.

The nurse is educating a patient about the discharge medication. When should the nurse instruct the patient to take the antacid medication? With the meal 30 minutes before the meal 1 to 3 hours after the meal Immediately after the meal

Correct response: 1 to 3 hours after the meal Explanation: In addition, an effort is made to neutralize acid by eating three regular meals a day. Small, frequent feedings are not necessary as long as an antacid or a histamine blocker is taken.

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

Correct response: O Explanation: People with blood type O are more susceptible to peptic ulcers than those with blood type A, B, or AB.

Which of the following are classified as a histamine-2 receptor antagonist? Pepcid Prevacid Flagyl Nexium

Correct response: Pepcid Explanation: Famotidine (Pepcid) is a histamine-2 receptor antagonist. Prevacid and Nexium are proton pump inhibitors (PPIs). Flagyl is an antibiotic.

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. Ranitidine (Zantac) Cimetidine (Tagamet) Famotidine (Pepcid) Omeprazole (Prilosec)

Correct response: Omeprazole (Prilosec) 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.

A client reports to the clinic, stating that she rapidly developed headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. For dinner, she ate buffalo chicken wings and beer. Which of the following medical conditions is most consistent with the client's presenting problems? Acute gastritis Duodenal ulcer Gastric cancer Gastric ulcer

Correct response: Acute gastritis Explanation: The client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccuping, 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.

Which of the following medications used for the treatment of obesity prevents the absorption of triglycerides? Bupropion hydrochloride (Wilburton) Sibutramine hydrochloride (Meridia) Fluoxetine hydrochloride (Prozac) Orlistat (Xenical)

Correct response: Orlistat (Xenical) Explanation: Orlistat (Xenical) prevents the absorption of triglycerides. Side effects of Xenical may include increased bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, and decreased absorption of some vitamins. Bupropion hydrochloride (Wellbutrin) is an antidepressant medication. Sibutramine hydrochloride (Meridia) inhibits the reuptake of serotonin and norepinephrine. Meridia decreases appetite. Fluoxetine hydrochloride (Prozac) has not been approved by the FDA for use in the treatment of obesity.

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease? To keep gastric pH at 3.0 to 3.5 To promote client compliance To maintain a regular bowel pattern To increase pepsin activity

Correct response: To keep gastric pH at 3.0 to 3.5 Explanation: To maintain a gastric pH of 3.0 to 3.5 throughout each 24-hour period, regular (not as needed) doses of an antacid are needed to treat peptic ulcer disease. Frequent administration of an antacid tends to decrease client compliance rather than promote it. Antacids don't regulate bowel patterns, and they decrease pepsin activity.

The nurse is caring for a client who underwent a subtotal gastrectomy 36 hours ago. The client has a nasogastric (NG) tube. The nurse knows to do the following with the NG: Apply suction to the NG tube every hour. Clamp the NG tube if the client complains of nausea. Irrigate the NG tube gently with normal saline if ordered. Reposition the NG tube if pulled out.

Correct response: Irrigate the NG tube gently with normal saline if ordered. Explanation: The nurse maintains functioning of the NG tube to prevent distention and secures the tube to prevent dislocation, which may result in increased pain and tension. The nurse can gently irrigate the tube if ordered, but must be careful not to reposition it. Repositioning can cause bleeding. Suction should be applied continuously---not every hour. The NG tube shouldn't be clamped postoperatively because secretions and gas will accumulate, stressing the suture line.

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

Correct response: 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 is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be: coffee-ground-like. clay-colored. black and tarry. bright red.

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

Correct response: 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 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. The nurse suspects the client has: dumping syndrome. dehiscence of the surgical wound. peritonitis. a normal reaction to surgery.

Correct response: dumping syndrome. Explanation: Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.

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

Correct response: pain 2 to 3 hours after a meal. Explanation: The patient with a gastric ulcer often awakens between 1 to 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the patient with duodenal ulcer. Hemorrhage is less likely in the patient with duodenal ulcer than the patient with gastric ulcer. The patient with a duodenal ulcer may experience weight gain.