Patients With Gastric and Duodenal Disorders
Which of the following medications is classified as a proton pump inhibitor (PPI)? a. Omeprazole b. Nizatidine c. Cimetidine d. Famotidine
a. Omeprazole Omeprazole is classified as a PPI. Nizatidine, cimetidine, and famotidine are classified as H2 receptor antagonists.
Which of the following is the most successful treatment for gastric cancer? a. Removal of the tumor b. Chemotherapy c. Radiation d. Palliation
a. Removal of the tumor 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 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
d. Six small meals daily with 120 mL fluid between meals After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals.
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
c. Peptic ulcers Chronic gastritis caused by Helicobacter pylori is implicated in the development of peptic ulcers. Chronic gastritis is sometimes associated with autoimmune disease, such as pernicious anemia, but not as a cause of the anemia. Chronic gastritis is not implicated in system infections and/or colostomies.
Endoscopy of a 60-year-old woman has revealed the presence of an esophageal peptic ulcer. The nurse who is providing this woman's care is assessing for risk factors that may have contributed to the development of this disease. What question most directly addresses these risk factors? a. "Have you ever been diagnosed with reflux?" b. "Do you consider yourself to have a healthy diet?" c. "Have you been prone to infections over the past few years?" d. "Do you ever find it difficult to swallow certain foods?"
a. "Have you ever been diagnosed with reflux?" Gastroesophageal reflux disease (GERD) is a significant risk factor for peptic ulcer disease. Poor diet, general infections, and dysphagia are less closely associated with etiology of esophageal ulcers.
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.
d. drink liquids only between 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.
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
c. 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.
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.
d. 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.
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
d. IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 The criteria for morbid obesity are a body weight that is twice IBW and a BMI that exceeds 30 kg/m2.
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
d. Omeprazole 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.
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? a. Duodenum b. Esophagus c. Pylorus d. Stomach
a. Duodenum Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.
A patient comes to the clinic complaining of pain in the epigastric region. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by what? a. Eating b. Drinking milk c. Suppressing emesis d. Having a bowel movement
a. Eating Taking antacids, eating, or vomiting often relieves the pain. Pain occurs about 2 hours after eating. Milk is contraindicated in relieving peptic ulcer pain.
Which medication is classified as a histamine-2 receptor antagonist? a. Famotidine b. Lansoprazole c. Metronidazole d. Esomeprazole
a. Famotidine Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.
A nurse assesses the stools of a client diagnosed with peptic ulcer disease. Inspection reveals black, tarry stools. The nurse would use which term to document this finding? a. melena b. hematemesis c. pyrosis d. achlorhydria
a. melena Melena is the term used to denote black, tarry stools. Hematemesis refers to blood in vomit. Pyrosis is a burning sensation in the esophagus and stomach that moves up to the mouth. Achlorhydria refers to an absence of hydrochloric acid in the stomach.
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
a. 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.
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.) a. "It can be caused by ingestion of strong acids." b. "You may have ingested some irritating foods." c. "Is it possible that you are overusing aspirin." d. "It is a hereditary disease." e. "It is probably your nerves."
a. "It can be caused by ingestion of strong acids." b. "You may have ingested some irritating foods." c. "Is it possible that you are overusing aspirin." 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.
Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. a. Constipation b. Hypocalcemia c. Severe peptic ulcers d. Extreme gastric hyperacidity e. Gastrin-secreting tumors of the pancreas
c. Severe peptic ulcers d. Extreme gastric hyperacidity e. Gastrin-secreting tumors of the pancreas 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 completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below should the nurse consider most significantly related to the etiology of the patient's health problem? a. Consumes one or more protein drinks daily b. Takes over-the-counter antacids frequently c. Smokes two packs of cigarettes daily d. Reports a history of social drinking on a weekly basis
c. Smokes two packs of cigarettes daily Smoking is a significant risk factor for chronic gastritis. Alcohol ingestion can lead to gastritis; however, this generally occurs in patients with a history of daily consumption of alcohol. Protein drinks do not result in gastric inflammation. Antacids do not contribute to the etiology of chronic gastritis.
A client is admitted with a gastrointestinal bleed. What client symptom may indicate a peptic ulcer perforation to the nurse? a. Sudden, severe upper abdominal pain b. Hypertension c. Bradycardia d. Soft abdomen
a. Sudden, severe upper abdominal pain The client with a peptic ulcer perforation may have symptoms such as sudden, sever upper abdominal pain, vomiting, fainting, an extremely tender and rigid (board-like) abdomen, and hypotension and tachycardia, indicating shock. The client with a bleeding peptic ulcer will not experience hypertension or bradycardia. The client's abdomen with a peptic ulcer bleed will not be soft, but rigid.
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
a. 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 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.
a. 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 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? a. Curling's ulcer b. Peptic ulcer c. Esophageal ulcer d. Meckel's ulcer
a. 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.
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.
a. Famotidine will inhibit gastric acid secretions. 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
a. Hematemesis 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.
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: a. Hemorrhage b. Intractable ulcer c. Perforation d. Pyloric obstruction
a. Hemorrhage 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.
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
a. 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 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
a. 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 patient presents to the walk-in clinic complaining of vomiting and burning in his mid-epigastria. The nurse knows that to confirm peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what? a. Infection with Helicobacter pylori b. Excessive stomach acid secretion c. Gastric irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs) d. Inadequate production of pancreatic enzymes
a. Infection with Helicobacter pylori H. pylori infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen. Other 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. Excessive stomach acid secretion, NSAIDs, and dietary indiscretion may all cause gastritis; however, peptic ulcers are caused by colonization of the stomach by H. pylori.
Computed tomography of a patient with a sudden onset of severe nausea and vomiting has revealed the presence of a pyloric obstruction. Which of the following interventions is the nurse's priority in the immediate care of this patient? a. Insertion of a nasogastric (NG) tube to suction to decompress the stomach b. Insertion of a central line for parenteral nutrition c. Administration of a saline enema to purge the lower bowel d. Gastric lavage
a. Insertion of a nasogastric (NG) tube to suction to decompress the stomach In treating the patient with pyloric obstruction, the first consideration is to insert an NG tube to decompress the stomach. Nutrition is not an immediate priority, and neither gastric lavage nor cleansing enemas is indicated.
A nurse is teaching a client about the need to use mineral supplements along with a multivitamin daily after bariatric surgery. Which minerals would the nurse include in the teaching? Select all that apply. a. Iron b. Folic acid c. Copper d. Sodium d. Potassium
a. Iron b. Folic acid c. Copper Client teaching includes taking two chewable multivitamins plus mineral (iron, folic acid, thiamine, copper, zinc) supplements daily and a dietary intake or supplementation of 1,200-1,500 mg of elemental calcium. Sodium and potassium supplements are not indicated.
An older adult patient had a gastrectomy performed several weeks ago and is being followed closely by the care team. Due to potential complications of this surgery, the nurse should closely monitor the patient's levels of: a. Iron and vitamin B12 b. Prealbumin and bilirubin c. Ionized calcium and C-reactive protein d. Creatinine and blood urea nitrogen (BUN)
a. Iron and vitamin B12 Dietary deficiencies associated with gastrectomy include malabsorption of organic iron, which may require supplementation with oral or parenteral iron, and a low serum level of vitamin B12, which may require supplementation by the intramuscular route. The other given blood values are not directly affected by gastrectomy.
A 32-year-old man who has a body mass index of 32 (morbidly obese) is considering bariatric surgery. In the time leading up to this surgery, which of the following nursing diagnoses will be the primary focus of interventions? a. Knowledge deficit related to the implications of bariatric surgery b. Altered growth and development related to obesity c. Risk for injury related to obesity d. Spiritual distress related to low body image
a. Knowledge deficit related to the implications of bariatric surgery Patient teaching is a priority in the preparation for bariatric surgery. Necessary counseling and education would be prioritized over growth and development and spiritual distress, although each may emerge and be addressed accordingly. In seeking bariatric surgery, the patient is likely already aware of the risks associated with obesity.
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. a. Liver b. Pancreas c. Bladder d. Duodenum e. Lungs
a. Liver b. Pancreas d. Duodenum 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.
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? a. Mental confusion b. Bradycardia c. Bradypnea d. Hypertension
a. Mental confusion Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.
A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply. a. Nizatidine b. Lansoprazole c. Famotidine d. Cimetidine e. Esomeprazole
a. Nizatidine c. Famotidine d. Cimetidine 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 medication classification represents a proton (gastric acid) pump inhibitor? a. Omeprazole b. Sucralfate c. Famotidine d. Metronidazole
a. Omeprazole 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.
The nurse is providing care to a client who has had a percutaneous liver biopsy. The nurse would monitor the client for which of the following? a. Signs and symptoms of bleeding b. Return of the gag reflex c. Passage of stool d. Intake and output
a. Signs and symptoms of bleeding A major complication after a liver biopsy is bleeding, so it would be important for the nurse to monitor the client for signs and symptoms of bleeding. Return of the gag reflex would be important for the client who had an esophagogastroduodenoscopy to prevent aspiration. Monitoring the passage of stool would be important for a client who had a barium enema or colonoscopy. Monitoring intake and output is a general measure indicated for any client. It is not specific to a liver biopsy.
A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply. a. Tachycardia b. Hypotension c. Mild epigastric pain d. A rigid, board-like abdomen e. Diarrhea
a. Tachycardia b. Hypotension d. A rigid, board-like abdomen Signs and symptoms of perforation include sudden, severe upper abdominal pain (persisting and increasing in intensity); pain, 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. Perforation is a surgical emergency.
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. Vasomotor symptoms associated with dumping syndrome b. Dehiscence of the surgical wound c. Peritonitis d. A normal reaction to surgery
a. Vasomotor symptoms associated with dumping syndrome 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, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.
A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? a. "Take the medication with milk." b. "Be sure to wear sunscreen while taking this medicine." c. "You will not experience GI upset while taking this medication." d. "Do not drive when taking this medication."
b. "Be sure to wear sunscreen while taking this medicine." 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? a. "I'm going to visit my pastor weekly for a while." b. "I will have to take vitamin B12 shots up to 1 year after surgery." c. "I will call my physician if I begin to have abdominal pain." d. "I will weight myself each day and record the weight."
b. "I will have to take vitamin B12 shots up to 1 year after surgery." 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.
An obese male patient has sought advice from the nurse about the possible efficacy of medications in his efforts to lose weight. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity? a. "Medications are usually reserved for people who have had unsuccessful bariatric surgery." b. "Medications may be of some use, but they don't tend to resolve obesity on their own." c. "Medications are an excellent option for individuals who prefer not to exercise or reduce their food intake." d. "Medications have the potential to reduce hunger but they rarely result in weight loss."
b. "Medications may be of some use, but they don't tend to resolve obesity on their own." Medications for obesity rarely result in loss of more than 10% of total body weight. They are not intended as a substitute for exercise or a healthy diet. They are not solely intended for those individuals who have undergone bariatric surgery.
A nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is a. Less than 5% b. 15% c. 25% d. Greater than 50%
b. 15% Fifteen percent of clients with peptic ulcer experience bleeding.
Which ulcer is associated with extensive burn injury? a. Cushing ulcer b. Curling ulcer c. Peptic ulcer d. Duodenal ulcer
b. Curling ulcer Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.
Clients with Type O blood are at higher risk for which of the following GI disorders? a. Gastric cancer b. Duodenal ulcers c. Esophageal varices d. Diverticulitis
b. Duodenal ulcers 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 patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that, in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what? a. Knowledge of the causes of obesity and its associated risks b. Emotional stability and understanding of required lifestyle changes. c. Positive body image and high self-esteem d. Insight into why their past weight loss efforts failed
b. Emotional stability and understanding of required lifestyle changes. Patients seeking bariatric surgery must be evaluated by a psychiatrist, psychologist, or advanced practice mental health nurse to establish that they are free of serious mental disorders and are motivated to comply with lifestyle changes related to eating patterns, dietary choices, and elimination. Obese patients are often unlikely to have a positive body image due to the social stigma associated with obesity. While assessment of knowledge about causes of obesity and its associated risks, as well as insight into the reasons why previous diets have been ineffective are included in the patient's plan of care, these do not predict positive patient outcomes following bariatric surgery. Most obese patients have an impaired body image and alteration in self-esteem. An obese patient with a positive body image would be unlikely to seek this surgery unless she or he was experiencing significant comorbidities.
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
b. Endoscopy 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 30-year-old obese female patient who underwent gastric banding 3 days ago is getting ready to go home. Essential postoperative teaching for this patient should include instruction related to the importance of abstaining from what for the next 2 years? a. Multivitamin supplements b. Pregnancy c. Antidepressants d. Control-top panty hose
b. Pregnancy Women of childbearing age who have had bariatric surgery should avoid pregnancy for approximately 2 years until their weight stabilizes, and it is evident that their nutritional needs are being adequately met. Multivitamins are generally recommended for the patient to supplement dietary sources of nutrients. Antidepressants may be taken if clinically indicated. Control-top pantyhose may be uncomfortable postoperatively; however, they are not contraindicated.
A client is diagnosed with peptic ulcer disease secondary to NSAID use. When preparing this client's plan of care, which medication would the nurse anticipate being prescribed? Select all that apply. a. ampicillin b. famotidine c. omeprazole d. bismuth e. sucralfate
b. famotidine c. omeprazole Histamine-2 (H2) receptor antagonists (H2 blockers), such as famotidine, and proton pump inhibitors (PPIs), such as omeprazole, are used to treat NSAID-induced ulcers and other ulcers not associated with H. pylori infection. The other drugs listed would be used as part of a regimen when H. pylori is involved.
The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? a. "I should stop all my medications if I develop any side effects." b. "I should continue my treatment regimen as long as I have pain." c. "I have learned some relaxation strategies that decrease my stress." d. "I can buy whatever antacids are on sale because they all have the same effect."
c. "I have learned some relaxation strategies that decrease my stress." The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.
A nurse is conducting discharge teaching for a client who has undergone gastric surgery. After teaching the client about diet, which statement by the client indicates a need for more teaching? a. "I'll lie down for about 20 minutes after eating." b. "I'll avoid drinking fluids with my meals." c. "I'll have meals that have more liquid-like foods than dry ones." d. "I'll make sure to avoid foods that are really sweet"
c. "I'll have meals that have more liquid-like foods than dry ones." Dietary management after gastric surgery includes the following instructions: To delay stomach emptying and dumping syndrome, the client should assume a low Fowler's position (head of bed [HOB] elevated 30 degrees) during mealtime; after the meal, the client should lie down for 20-30 minutes; the client should not drink fluids with meals; instead, the client should drink fluids up to 1 hour before or 1 hour after mealtime; the client should create meals containing more dry items than liquid items; the client should eat fat as tolerated, but keep carbohydrate intake low and avoid concentrated sources of carbohydrates (sugared soda, pastries); the client should eat smaller but more frequent meals.
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? a. "My ulcer will heal because these medications will kill the bacteria." b. "I should take these medications only when I have pain from my ulcer." c. "The medications will kill the bacteria and stop the acid production." d. "These medications will coat the ulcer and decrease the acid production in my stomach."
c. "The medications will kill the bacteria and stop the acid production." 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.
An older adult patient with a diagnosis of chronic gastritis has achieved acceptable control of his condition with the use of an H2 receptor antagonist. This patient's symptom control is a result of what therapeutic action of this drug? a. The occlusion of parietal cells b. An increase in the pH of gastric secretions c. A decrease in HCl production by parietal cells d. Activation of the gastric buffer system and release of alkaline gastric secretions
c. A decrease in HCl production by parietal cells Histamine-2 receptor antagonists decrease the amount of HCl produced by stomach by blocking action of histamine on histamine receptors of parietal cells in the stomach. They do not directly increase the pH of gastric secretions, and they do not activate a buffer system or occlude parietal cells.
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? a. Vomiting b. Hemorrhage c. Awakening in pain d. Constipation
c. 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.
As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene? a. Rejoice with the client. b. Notify the health care provider that the client is eager to sign the consent form. c. Evaluate the client's understanding of the procedure. d. Ask the client about his or her plans for after surgery.
c. Evaluate the client's understanding of the procedure. The nurse should evaluate the client's understanding of the procedure. The client may not understand that surgery alone isn't a cure for obesity; lifestyle modifications and counseling are also necessary. Based on the client's comment, the client isn't fully informed; therefore, signing an informed consent form without further teaching would be inappropriate. Rejoicing with the client is inappropriate. Asking the client about plans for after surgery redirects the conversation away from the client's misinterpretation of the procedure.
The nurse is performing detailed patient education with a 40-year-old woman who will be soon discharged following a Roux-en-Y gastric bypass. The nurse and other members of the interdisciplinary team have been emphasizing the need for eating small amounts of food at a sitting and eating food slowly. What is the rationale for the nurse's advice? a. Eating too quickly can cause gastric ulceration. b. The cardiac sphincter is unable to dilate quickly after bariatric surgery. c. Nausea and esophageal distention can result from eating too fast. d. Eating quickly is associated with weight gain.
c. Nausea and esophageal distention can result from eating too fast. Because of the physical alterations to the upper gastrointestinal (GI) tract that are created during bariatric surgery, the patient is prone to nausea and esophageal distention if he or she eats too quickly. Eating quickly does not contribute to ulceration or weight gain following surgery. The cardiac sphincter is not modified during bariatric surgery.
A client taking metronidazole for the treatment of H. pylori states that the medication is causing nausea. What teaching should the nurse provide to the client to alleviate the nausea? a. Discontinue the use of the medication. b. Ask the healthcare provider to prescribe another type of antibiotic. c. Take the medication with meals to decrease the nausea. d. Crush the medication and put it in applesauce.
c. Take the medication with meals to decrease the nausea. Metronidazole (Flagyl) should be administered with meals to decrease GI upset. The client should not stop the medication without discussing it with a prescribing healthcare provider. Crushing the medication will not help the nausea because it is the same medication.
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.
c. 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.
A 70-year-old woman with a complex medical history made an appointment with her primary care provider because she has recently been experiencing heartburn, abdominal pain, and nausea. The clinician has identified that the woman's symptoms are characteristic of acute gastritis. Which of the woman's following statements is suggestive of the etiology of her problem? a. "I remember my father often complaining about heartburn and indigestion." b. "I've been taking glucosamine supplements because I've been told they'll help my arthritis." c. "My endocrinologist recently increased my dose of metformin that I take for my diabetes." d. "I've changed from taking Tylenol for my arthritis pain to taking aspirin."
d. "I've changed from taking Tylenol for my arthritis pain to taking aspirin." Overuse of aspirin is frequently implicated in cases of acute gastritis. Family history and the use of glucosamine and metformin are not common contributors to acute gastritis.
A client with morbid obesity and a history of severe sleep apnea and severe diabetes is being considered for bariatric surgery. When reviewing the client's medical record, the nurse would identify that which body mass index (BMI) would meet the criteria for such surgery? a. 30kg/m2 b. 32 kg/m2 c. 34 kg/m2 d. 36 kg/m2
d. 36 kg/m2 To meet the criteria for bariatric surgery, the client must have a BMI of at least 35 kg/m2 with obesity-associated comorbidity (e.g., severe sleep apnea, hypertension, cardiomyopathy related to obesity, severe diabetes mellitus, and serious musculoskeletal or neurologic disorders).
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? a. Ineffective treatment for the peptic ulcer b. A reaction to the medication given for the ulcer c. Gastric penetration d. Perforation of the peptic ulcer
d. Perforation of the peptic ulcer 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.
Which statement correctly identifies a difference between duodenal and gastric ulcers? a. Malignancy is associated with duodenal ulcer. b. Weight gain may occur with a gastric ulcer. c. A gastric ulcer is caused by hypersecretion of stomach acid. d. Vomiting is uncommon in clients with duodenal ulcers.
d. Vomiting is uncommon in clients with duodenal ulcers. Vomiting is uncommon in clients diagnosed with duodenal ulcer. Malignancy is associated with a gastric ulcer. Weight gain may occur with a duodenal ulcer. Duodenal ulcers cause hypersecretion of stomach acid.
