Exam 3 Chapter 46 GI

A client with gastric cancer has been scheduled for a total gastrectomy. During the preoperative assessment, the client confides in the nurse that she feels like she will be "mutilated by the surgery." The nurse should plan interventions that address what? Disturbed body image Deficient knowledge related to the risks of surgery Anxiety about the surgery Low self-esteem

Disturbed body image

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? Dumping syndrome Dehiscence of the surgical wound Peritonitis A normal reaction to surgery

Dumping syndrome

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 call my physician if I begin to have abdominal pain." "I will weight myself each day and record the weight."

"I will have to take vitamin B12 shots up to 1 year after surgery."

A nurse is caring for a client who has had extensive abdominal surgery and is in critical condition. The nurse notes that the complete blood count shows an 8 G/dL hemoglobin and a 30% hematocrit. Dextrose 5% in half-normal saline solution is infusing through a triple lumen central catheter at 125 mL/hr. The physician orders include the following:Gentamicin 80 mg IV piggyback in 50 mL D5W over 30 minutesZantac 50 mg IV piggyback in 50 mL D5W over 30 minutesOne unit of 250 mL of PRBCs (packed red blood cells) over 3 hoursFlush the nasogastric tube with 30 mL normal saline every 2 hours.How many milliliters should the nurse record as the intake for the 8-hour shift? Enter the correct number ONLY.

1470

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. Ascites Hepatomegaly Distended bladder Sister Mary Joseph's nodules Petechiae at the palpation site

Ascites Hepatomegaly

A nurse is providing care for a client who is postoperative day 2 following gastric surgery. The nurse's assessment should be planned in light of the possibility of what potential complications? Select all that apply. Malignant hyperthermia Atelectasis Pneumonia Hemorrhage Chronic gastritis

Atelectasis Pneumonia Hemorrhage

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

Diet

The nurse is caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client? Drink a minimum of 12 ounces of fluid with each meal. Eat several small meals daily spaced at equal intervals. Choose foods that are high in simple carbohydrates. Sit upright when eating and for 30 minutes afterward.

Eat several small meals daily spaced at equal intervals.

A client has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the client should adopt what dietary guidelines? Eat small, frequent meals with high calorie and vitamin content. Eat frequent meals with an equal balance of fat, carbohydrates, and protein. Eat frequent, low-fat meals with high protein content. Try to maintain the pre-diagnosis pattern of eating.

Eat small, frequent meals with high calorie and vitamin content.

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

Fowler's

Which of the following is a true statement regarding gastric cancer? Most patients are asymptomatic during the early stage of the disease. Women have a higher incidence of gastric cancer than men. The prognosis for gastric cancer is generally considered good. Most cases of gastric cancer are discovered prior to metastasis.

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

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? Notify the health care provider. Reposition the tube. Irrigate the tube. Increase the suction level.

Notify the health care provider.

Which of the following is considered an early symptom of gastric cancer? Pain relieved by antacids Weight loss Bloating after meals Dyspepsia

Pain relieved by antacids

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

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

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

Wide resection of the middle and distal portions of the stomach with removal of about 75% of the stomach

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.

drink liquids only between meals.

The nurse is admitting a client whose medication regimen includes regular injections of vitamin B12. The nurse should question the client about a history of: total gastrectomy. bariatric surgery. diverticulitis. gastroesophageal reflux disease (GERD).

total gastrectomy.

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. Liver Pancreas Bladder Duodenum Lungs

Liver Pancreas Duodenum

A nurse is providing anticipatory guidance to a client who is preparing for a total gastrectomy. The nurse learns that the client is anxious about numerous aspects of the surgery. What intervention is most appropriate to alleviate the client's anxiety? Emphasize the fact that gastric surgery has a low risk of complications. Encourage the client to focus on the benefits of the surgery. Facilitate the client's contact with support services. Obtain an order for a PRN benzodiazepine.

Facilitate the client's contact with support services.

A client who underwent a gastric resection 3 weeks ago is having her diet progressed on a daily basis. Following her latest meal, the client reports dizziness and palpitations. Inspection reveals that the client is diaphoretic. What is the nurse's best action? Insert a nasogastric tube promptly. Reposition the client supine. Monitor the client closely for further signs of dumping syndrome. Assess the client for signs and symptoms of aspiration.

Monitor the client closely for further signs of dumping syndrome.

A client is recovering in the hospital following gastrectomy. The nurse notes that the client has become increasingly difficult to engage and has had several angry outbursts at staff members in recent days. The nurse's attempts at therapeutic dialogue have been rebuffed. What is the nurse's most appropriate action? Ask the client's primary provider to liaise between the nurse and the client. Delegate care of the client to a colleague. Limit contact with the client in order to provide privacy. Make appropriate referrals to services that provide psychosocial support.

Make appropriate referrals to services that provide psychosocial support.

A community health nurse is preparing for an initial home visit to a client discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include? Enteral feeding via gastrostomy tube (G tube) Gastrointestinal decompression by nasogastric tube Periodic assessment for esophageal distension Administration of injections of vitamin B12

Administration of injections of vitamin B12

A client has a family history of stomach cancer. Which factor would further increase the client's risk for developing gastric cancer? Select all that apply. High intake of fruits and vegetables Age 55 years Female gender Caucasian ancestry Previous infection with H. pylori

Age 55 years Previous infection with H. pylori

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 Bloating after meals Increased appetite

Bloating after meals

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? Discharge planning Correcting nutritional deficits Preventing deep vein thrombosis (DVT) Teaching about radiation treatment

Correcting nutritional deficits

A client has given a confirmed diagnosis of gastric cancer. Which procedure is important to assess tumor depth? Barium x-ray of the upper GI tract Esophagogastroduodenoscopy (EGD) Computed tomography (CT) Endoscopic ultrasound

Endoscopic ultrasound

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

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

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 Allows for better absorption of vitamin B12 Removes tension on internal suture line

Slows gastric emptying

A client has recently received a diagnosis of gastric cancer; the nurse is aware of the importance of assessing the client's level of anxiety. Which of the following actions is most likely to accomplish this? The nurse gauges the client's response to hypothetical outcomes. The client is encouraged to express fears openly. The nurse provides detailed and accurate information about the disease. The nurse closely observes the client's body language.

The client is encouraged to express fears openly.

Diagnostic testing of a client with a history of dyspepsia and abdominal pain has resulted in a diagnosis of gastric cancer. The nurse's anticipatory guidance should include what information? The possibility of surgery, chemotherapy and radiotherapy The possibility of needing a short-term or long-term colostomy The benefits of weight loss and exercise as tolerated during recovery The good prognosis for clients who are treated for gastric cancer

The possibility of surgery, chemotherapy and radiotherapy

The nurse is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75? Abdominal mass Agitation Hepatomegaly Ascites

Agitation

A nurse is admitting a client diagnosed with late-stage gastric cancer. The client's family is distraught and angry that she was not diagnosed earlier in the course of her disease. What factor most likely contributed to the client's late diagnosis? Gastric cancer does not cause signs or symptoms until metastasis has occurred. Adherence to screening recommendations for gastric cancer is exceptionally low. Early symptoms of gastric cancer are usually attributed to constipation. The early symptoms of gastric cancer are usually not alarming or highly unusual.

The early symptoms of gastric cancer are usually not alarming or highly unusual.

Which is an accurate statement regarding gastric cancer? The incidence of stomach cancer continues to decrease in the United States. Most gastric cancer-related deaths occur in people younger than 40 years. Females have a higher incidence of gastric cancers than males. A diet high in smoked foods and low in fruits and vegetables may decrease the risk of gastric cancer.

The incidence of stomach cancer continues to decrease in the United States.