Prep U 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? a) "Be sure to wear sunscreen while taking this medicine." b) "Do not drive when taking this medication." c) "Expect a metallic taste when taking this medicine, which is normal." d) "Take the medication with milk."

"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.

Which of the following clients is at highest risk for peptic ulcer disease? a) A 52-year-old male accountant b) A 19-year-old female college student c) A 72-year-old grandfather of four d) A 31-year-old pregnant woman

A 52-year-old male accountant Explanation: Peptic ulcer disease occurs with the greatest frequency in people 40 and 60 years old. It is relatively uncommon in women of childbearing age, but it has been observed in children and even in infants. After menopause, the incidence of peptic ulcers in women is almost equal to that in men.

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? a) Gastric cancer b) Duodenal ulcer c) Acute gastritis d) Gastric ulcer

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

Symptoms associated with pyloric obstruction include all of the following except: a) Anorexia b) Nausea and vomiting c) Diarrhea d) Epigastric fullness

Diarrhea Explanation: 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 client may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

Which of the following is the first portion of the small intestine? a) Pylorus b) Omentum c) Peritoneum d) Duodenum

Duodenum Explanation: The duodenum is the first portion of the small intestine, between the stomach and the jejunum. The pylorus is the opening between the stomach and duodenum. The peritoneum is the thin membrane that lines the inside of the wall of the abdomen and covers all the abdominal organs. The omentum is the fold of the peritoneum that surrounds the stomach and other organs of the abdomen.

Which of the following medications is classified as a proton pump inhibitor (PPI)? a) Ranitidine b) Famotidine c) Omeprazole d) Cimetidine

Omeprazole Explanation: Omeprazole is classified as a PPI. Ranitidine, Cimetidine, and Famotidine are classified as H2 receptor antagonists.

Which of the following represents the medication classification of a proton (gastric acid) pump inhibitor? a) Famotidine (Pepcid) b) Metronidazole (Flagyl) c) Sucralfate (Carafate) d) Omeprazole (Prilosec)

Omeprazole (Prilosec) 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 nurse is caring for a client who had gastric bypass surgery 2 days ago. Which assessment finding requires immediate intervention? a) The client states he is nauseated. b) The client states he has been passing gas. c) The client complains of pain at the surgical site. d) The client's right lower leg is red and swollen.

The client's right lower leg is red and swollen. Explanation: A red, swollen extremity is a possible sign of a thromboembolism, a common complication after gastric surgery because of the fact that the clients are obese and tend to ambulate less than other surgical clients. The nurse should inform the physician of the finding. Pain at the surgical site should be investigated, but the red, swollen leg is a higher priority. It isn't unusual for a client to be nauseated after gastric bypass surgery. The nurse should follow up with the finding, but only after she has notified the physician about the possible thromboembolism. Passing gas is normal and a sign that the client's intestinal system is beginning to mobilize.

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

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.

Choice Multiple question - Select all answer choices that apply. A client with peptic ulcer disease wants to know nonpharmacological ways that he can prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. a) Substitution of coffee with decaffeinated products b) Eating whenever hungry c) Following a regular schedule for rest, relaxation, and meals d) Avoidance of alcohol e) Smoking cessation

• Following a regular schedule for rest, relaxation, and meals • Smoking cessation • Avoidance of alcohol Explanation: The likelihood of recurrence is reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, and alcohol. It is important to counsel the client to eat meals at regular times and in a relaxed setting and to avoid overeating.

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

Most patients are asymptomatic during the early stage of the disease. Explanation: Most patients are asymptomatic during the early stage of the disease. Men have a higher incidence of gastric cancer. The prognosis is poor because the diagnosis is usually made late because most patients are asymptomatic during the early stage. Most cases of gastric cancer are discovered only after local invasion has advanced or metastases are present.

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? a) Three meals and three snacks and 120 mL fluid daily b) Six small meals and 120 mL fluid daily c) Three meals and 120 ml fluid daily d) Six small meals daily with 120 mL fluid between meals

Six small meals daily with 120 mL fluid between meals Explanation: 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.

daily fluid goal

Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals. 120 X 6 = 720 mL.

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, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed? a) Penetration b) Hemorrhage c) Pyloric obstruction d) Perforation

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 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. The nurse suspects: a) Dehiscence of the surgical wound b) A normal reaction to surgery c) Vasomotor symptoms associated with dumping syndrome d) Peritonitis

Vasomotor symptoms associated with 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.

Choice Multiple question - Select all answer choices that apply. Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. a) Hypocalcemia b) Constipation c) Extreme gastric hyperacidity d) Severe peptic ulcers e) Gastrin-secreting tumors of the pancreas

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

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 to his right shoulder. The intial appropriate action by the nurse is to a) Assess the client's abdomen and vital signs. b) Notify the health care provider. c) Place the client in the high-Fowler's position. d) Irrigate the client's NG tube.

Assess the client's abdomen and vital signs. Explanation: 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.

Peptic ulcer disease occurs more frequently in people with which blood type? a) AB b) A c) O d) B

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 appears to be a significant factor in the development of gastric cancer? a) Age b) Diet c) Gender d) Ethnicity

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 Caucasian Americans to develop gastric cancer.

A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a) Nothing by mouth b) Skim milk c) Clear liquids d) Regular diet

Nothing by mouth Explanation: Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A clear liquid diet is the first diet offered after bleeding and shock are controlled.

A client is admitted to the hospital with an exacerbation of his chronic gastritis. When assessing his nutritional status, the nurse should expect a deficiency in: a) vitamin B12. b) vitamin A. c) vitamin C. d) vitamin B6.

vitamin B12. Explanation: The nurse should expect vitamin B12 deficiency. Injury to the gastric mucosa causes gastric atrophy and impaired function of the parietal cells. These changes result in reduced production of intrinsic factor, which is necessary for the absorption of vitamin B12. Eventually, pernicious anemia will occur. Deficiencies in vitamins A, B6, and C aren't expected in a client with chronic gastritis.