Brunners CH 46 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.
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." "It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." hereditary
"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." (NOT hereditary)
Which of the following interventions are appropriate for clients with gastritis? Select all that apply. --Give the client food and fluids every 4 hours. Or --Provide general education about how to prevent recurrences.
--Provide general education about how to prevent recurrences.
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
A client has a family history of stomach cancer. Which of the following factors would further increase the client's risk for developing gastric cancer? Select all that apply. Female gender Age 55 years Previous infection with H. pylori caucasion
Age 55 years Previous infection with H. pylori (Not caucasion)
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.
Which of the following appears to be a significant factor in the development of gastric cancer? a) Age b) Diet c) Gender d) Ethnicity
B )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.
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
C) Following a regular schedule for rest, relaxation, and meals E) Smoking cessation D) 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.
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 of the following explanations from the nurse would be most accurate?
Correct response: "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery."
A client admitted for treatment of a gastric ulcer is being prepared for discharge. The client will follow a regimen of antacid therapy. Discharge teaching should include which instructions? Choose all that apply. "Be sure to take antacids with meals." "Continue to take antacids even if your symptoms subside." "You may be prescribed H2-receptor antagonists for up to 1 year."
Correct response: "Continue to take antacids even if your symptoms subside." "You may be prescribed H2-receptor antagonists for up to 1 year." (don't take antacid with meal)
After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? "A total serving should amount to be less than one cup." Or "I need to drink 8 ounces of water before eating."
Correct response: "I need to drink 8 ounces of water before eating."
A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen?
Correct response: 10 to 14 days
Morbid obesity is defined as being how many pounds over the person's ideal body weight? 75 Or 100
Correct response: 100
The nurse is conducting preoperative teaching to a patient prior to bariatric surgery. The nurse includes that the average weight loss of patients after bariatric surgery is which percent of their presurgical body weight? 5 to 15% Or 25 to 35%
Correct response: 25 to 35%
A client weighs 215 lbs and is 5' 8" tall. The nurse would calculate this client's body mass index (BMI) as which of the following?
Correct response: 32.7 Explanation: Using the formula for BMI, the client's weight in pounds (215) is divided by the height in inches squared (68 inches squared) and then multiplied by 703. The result would be 32.7.
A patient is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What is the name of this surgical procedure for peptic ulcer disease? Pyloroplasty Or Billroth I
Correct response: Billroth I
The health care provider prescribes a combination of three drugs to treat peptic ulcer disease. The nurse, preparing to review the drug actions and side effects with the patient, understands that the triple combination should be in which of the following order?
Correct response: Bismuth salts, antibiotics, and proton pump inhibitors
The nurse is conducting an admission assessment and determines that the patient's BMI is 37. The nurse documents the BMI as being which of the following classes of obesity?
Correct response: Class II Explanation: The nurse documents the BMI of 37 as class II obesity (BMI 35 to 40).The other classifications are as follows: overweight (BMI 25 to 30); class I (BMI 30 to 35); class III (BMI > 40).
A client has given a confirmed diagnosis of gastric cancer. Two more procedures may be performed to assess tumor depth and lymph node involvement and surgical resectability. Which two are the procedures? Choose the two that apply. Esophagogastroduodenoscopy (EGD) Computed tomography (CT) Endoscopic ultrasound
Correct response: Computed tomography (CT) Endoscopic ultrasound
Which of the following ulcers is associated with extensive burn injury?
Correct response: Curling's ulcer
Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the patient be educated about regarding this event? Gastric outlet obstruction Or Dumping syndrome
Correct response: Dumping syndrome
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?
Correct response: Endoscopy
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? Rejoice with the client. Or Evaluate the client's understanding of the procedure.
Correct response: Evaluate the client's understanding of the procedure. (not evaluate plan after)
A nurse practitioner is considering pharmacological treatment options for a client with gastritis. Which of the following might limit the use of metronidazole (Flagyl) for this client? Select all that apply.
Correct response: History of alcoholism Current use of warfarin (Coumadin)
The nurse is aware that hemorrhage is a common complication of peptic ulcer disease. Therefore, assessment for indicators of bleeding is an important nursing responsibility. Which of the following are indicators of bleeding? Select all that apply. Bradycardia Polyuria Melina Tachypnea Thirst Mental confusion
Correct response: Melena Tachypnea Thirst Mental confusion (not bardycardi, and not polyuria
The nurse in the ED admits a patient with suspected gastric outlet obstruction. The patient's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which of the following orders?
Correct response: Nasogastric (NG) tube insertion
A nursing student notes that a client has a new physician order for a proton-pump inhibitor. The student knows that a frequently prescribed proton-pump inhibitor of gastric acid is Pepcid Or Nexium
Correct response: Nexium
The nurse is conducting a community health education program on obesity. The nurse includes which of the following diseases/disorders in the program?
Correct response: Obstructive sleep apnea
A patient is in the hospital for the treatment of peptic ulcer disease. The nurse finds the patient vomiting and complaining of a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate?
Correct response: Perforation of the peptic ulcer
The nurse is caring for a patient who is suspected to have developed a peptic ulcer hemorrhage. Which action would the nurse perform first? Prepare a peripheral and central line for intravenous infusion. Or Place the patient in a recumbent position with the legs elevated.
Correct response: Place the patient in a recumbent position with the legs elevated.
nurse is preparing to discharge a client newly diagnosed with peptic ulcer disease. The client's diagnostic test results were positive for H. pylori bacteria. The doctor has ordered the "triple therapy" regimen. Which of the following is the correct representation of "triple therapy" refers?
Correct response: Proton-pump inhibitor and two antibiotics
A patient taking metronidazole (Flagyl) for the treatment of H. pylori states that the medication is causing nausea. What suggestion can the nurse provide to the patient to alleviate this problem? Tell the patient to ask the physician to prescribe another type of antibiotic. Or Take the medication with meals to decrease the nausea.
Correct response: Take the medication with meals to decrease the nausea.
Which of the following statements correctly identifies a difference between duodenal and gastric ulcers? Weight gain may occur with a gastric ulcer. Or Vomiting is uncommon in patients with duodenal ulcers.
Correct response: Vomiting is uncommon in patients with duodenal ulcers.
After a client received a diagnosis of gastric cancer, the surgical team decides that a Billroth II would be the best approach to treatment. The nurse explains to the family that this procedure involves; Limited resection in the distal portion of the stomach and removal of about 25% of the stomach Or Wide resection of the middle and distal prtions of the stomach with removal of about 75% of the stomach
Correct response: Wide resection of the middle and distal prtions of the stomach with removal of about 75% of the stomach
A nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has:
Correct response: peptic ulcer disease.
The nurse reviews dietary guidelines with a patient who had a gastric banding. Which of the following teaching points are included? Select all that apply. - Do not eat and drink at the same time. - Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. -Avoid fruit drinks and soda. - Eat six meals a day. - Limit meal size to 450 to 500 mL.
Correct response: - Do not eat and drink at the same time. - Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. -Avoid fruit drinks and soda. NOT - Eat six meals a day. - Limit meal size to 450 to 500 mL.
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:
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? A) Barium study of the upper gastrointestinal tract B)Endoscopy C) Gastric secretion study D) Stool antigen test
Correct response: Endoscopy
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:
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.
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
E) Gastrin-secreting tumors of the pancreas C) Extreme gastric hyperacidity D) 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.
daily fluid goal w 6 meals
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.
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: A) Apply suction to the NG tube every hour. B) 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. C)Irrigate the NG tube gently with normal saline if ordered.
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.
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 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.
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 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 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.
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.
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.
assist with weight loss. The nurse knows that the client would not be a candidate for sibutramine HCl (Meridia) if the following is part of the client's health history:
You Selected: Coronary artery disease Correct response:
Which of the following are signs/symptoms of perforation?
You Selected: Sudden, severe upper abdominal pain
colostomy
a surgical operation that creates an opening from the colon to the surface of the body to function as an anus
What are signs on bleeding in output?
black tarry -bleed in stool coffee-ground-bleed in emesis
inflammatory bowel syndrome
chronic functional disorder characterized by recurrent abdominal pain that affects frequency of defecation and consistency of stools
hemorrhoids
dilated or varicose veins in the rectal or anal area
steatorrhea
fat in the feces
constipation
fewer than 3 bowel movements per week that are hard, dry, small, or difficult to pass
diarrhea
frequent passage of loose, watery stools
inflammatory bowel disease (IBD)
group of chronic disorders (ulcerative colitis and Crohn's disease) that result in inflammation or ulceration (or both) of the bowel lining
malabsorption
impaired transport across the mucosa
Diverticulitis
inflammation of a diverticulum
peritonitis
inflammation of the lining of the abdominal cavity
abscess
localized collection of pus
fissure
normal or abnormal tract that arise between two internal organs or between an internal organ and the body surface
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.
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.
gastrocolic reflex
peristaltic movements of the large bowel occurring five to six times daily that are triggered by distention of the stomach
diverticulum
saclike out-pouching of the lining of the bowel protruding through the muscle of the intestinal wall
Tenesmus
straining to defecate
ileosotomy
surgical opening into the ileum by means of a stoma to allow drainage of bowel contents
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.
