Prep U Chapter 40: Management of Patients with Gastric and Duodenal Disorders

A client comes to the clinic reporting pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the client has a peptic ulcer? "Do you find that your pain is worse when you need to have a bowel movement?" "Does your pain resolve when you have something to eat?" "Do over-the-counter pain medications help your pain?" "Does your pain get worse if you get up and do some exercise?"

"Does your pain resolve when you have something to eat?"

The nurse is teaching a client about peptic ulcers. The client understands the provided education when stating which of the following? "Hemorrhage and gastritis are the most common complications." "I will take over-the-counter antacids for severe abdominal pain." "Frequent vomiting is a normal sign of peptic ulcers." "My temperature and blood pressure will remain elevated until the ulcer is healed."

"Hemorrhage and gastritis are the most common complications."

The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? "I can buy whatever antacids are on sale because they all have the same effect." "I should stop all my medications if I develop any side effects." "I should continue my treatment regimen as long as I have pain." "I have learned some relaxation strategies that decrease my stress."

"I have learned some relaxation strategies that decrease my stress."

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 think the soda that I drank irritated my stomach." "I only ate dinner yesterday and it gave me an upset stomach." "I felt better but then just got really nauseated and threw up." "The pain stopped so I stopped taking the medications."

"The pain stopped so I stopped taking the medications."

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 sectioned portion of the stomach is joined to the jejunum. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. The antral portion of the stomach is removed and a vagotomy is performed. The vagus nerve is cut and gastric drainage is established.

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

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 sectioned portion of the stomach is joined to the jejunum. The antral portion of the stomach is removed and a vagotomy is performed. The vagus nerve is cut and gastric drainage is established. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.

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? Acute gastritis Gastric cancer Duodenal ulcer Gastric ulcer

Acute gastritis

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? Place the client in the high-Fowler's position. Assess the client's abdomen and vital signs. Irrigate the client's NG tube. Notify the health care provider.

Assess the client's abdomen and vital signs.

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 Black and tarry Coffee-ground-like Bright red

Black and tarry

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 between meals. drink liquids only with meals. don't drink liquids 2 hours before meals. restrict fluid intake to 1 qt (1,000 ml)/day.

drink liquids only between meals.

The nurse is caring for a client with hypovolemia related to prolonged vomiting and decreased intake of oral fluids. What activity(ies) should the nurse include in the client's plan of care? Select all that apply. Inform the primary health care provider if urine output is 3.5 oz (103 ml) per day or lower. Encourage the client to drink a 16 oz (480 ml) glass of water over the course of 15 minutes. Administer intravenous fluids as ordered. Offer the client a low-fat and high-protein meal. Advise the client to avoid alcohol.

dvise the client to avoid alcohol. Administer intravenous fluids as ordered.

The nurse is cautiously assessing a client admitted with peptic ulcer disease. The nurse is aware that which complications occur in 20% to 30% of clients with this diagnosis? intractable ulcer or pyrosis pyloric obstruction or melena hemorrhage or perforation perforation or mechanical obstruction

hemorrhage or perforation

The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. The nurse recognizes that an agent that is used to decrease bleeding and decrease gastric acid secretions is octreotide (Sandostatin) nizatidine (Axid) vasopressin (Pitressin) omeprazole (Prilosec)

octreotide (Sandostatin)

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

pain 2 to 3 hours after a meal.

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

pain 2 to 3 hours after a meal.

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine. Before the client is discharged, the nurse should provide which instruction? "Avoid aspirin and products that contain aspirin." "Increase your intake of fluids containing caffeine." "Stop taking the drugs when your symptoms subside." "Eat three balanced meals every day."

"Avoid aspirin and products that contain aspirin."

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

"Be sure to wear sunscreen while taking this medicine."

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 intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems." "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."

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

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

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

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.) "It is probably your nerves." "Is it possible that you are overusing aspirin." "It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "It is a hereditary disease."

"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin."

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? "My appetite may increase while taking this medication." "It might cause a metallic taste in my mouth." "I can take this medication with my blood thinner." "I can have an alcoholic drink in the evenings."

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

A client with peptic ulcer disease asks for pain medication. Which response will the nurse make? "The medications for the ulcer will reduce the pain." "I will ask the health care provider to prescribe pain medication." "Eating more food will help reduce the pain." "Using pain medication is what caused the ulcer to develop."

"The medications for the ulcer will reduce the pain."

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? Gastric outlet obstruction Celiac disease Bile reflux Dumping syndrome

Dumping syndrome

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? 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. Drink a minimum of 12 ounces of fluid with each meal.

Eat several small meals daily spaced at equal intervals.

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

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 Gastric secretion study Barium study of the upper gastrointestinal tract Endoscopy

Endoscopy

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

Famotidine

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? Hematemesis Polyuria Hypertension Bradycardia

Hematemesis

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? Pyloric obstruction Penetration Perforation Hemorrhage

Hemorrhage

Which of the following manifestations are associated with a deficiency of vitamin B12? Select all that apply. Loss of hair Lethargy Macrocytic anemia Thrombocytopenia Pernicious anemia

Pernicious anemia Macrocytic anemia Thrombocytopenia

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

Mental confusion

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

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

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 Pelvic x-ray Oral contrast

Nasogastric tube insertion

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

Nizatidine Famotidine Cimetidine

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.

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. Omeprazole Cimetidine Famotidine Nizatidine

Omeprazole

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

Omeprazole

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? Peptic ulcers Systemic infection Colostomy Pernicious anemia

Peptic ulcers

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

Six small meals daily with 120 mL fluid between meals

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? Removes tension on internal suture line Provides much needed rest Slows gastric emptying Allows for better absorption of vitamin B12

Slows gastric emptying

A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client? Ensure adequate potassium intake during therapy Take the medication at bedtime to accommodate sedative effects Take the medication 2 hours before or after other medications Blood levels will be evaluated after 1 week

Take the medication 2 hours before or after other medications

Which of the following interventions are appropriate for clients with gastritis? Select all that apply. Notify the physician of indicators of hemorrhagic gastritis. Discourage cigarette smoking. Provide general education about how to prevent recurrences. 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.

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 normal reaction to surgery Vasomotor symptoms associated with dumping syndrome Dehiscence of the surgical wound Peritonitis

Vasomotor symptoms associated with dumping syndrome

The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid decaffeinated coffee. acetaminophen. skim milk. octreotide.

decaffeinated coffee.