Care of Patients with Stomach Disorders Ch.55

What statement about type A gastritis is most accurate? It has an autosomal recessive pattern of inheritance. It is associated with pernicious anemia. It is most often caused by H. pylori infection. It can occur due to exposure to benzene or lead.

A genetic link to type A gastritis has been found in the relatives of those who have pernicious anemia. The gene has an autosomal dominant pattern of inheritance. Type B gastritis is most often caused by H. pylori infection. Atrophic gastritis may occur due to exposure to toxins such as benzene or lead.

The nurse assesses that a client experiences regular epigastric discomfort that usually goes away after eating. Which initial nursing action is correct? Contact the provider to report these symptoms. Order a low-fat, bland diet to prevent discomfort. Request an order for an H2-receptor antagonist. Teach the client to avoid nonsteroidal antiinflammatory drugs and aspirin.

Clients with epigastric discomfort that usually abates after eating may have chronic gastritis and should be evaluated for this disease. The nurse should report these symptoms to the provider. Ordering a low-fat diet, requesting an order for an H2-receptor antagonist, and teaching the client to avoid NSAIDs and aspirin are all correct actions only after a diagnosis of gastritis has been made.

A client asks the nurse how an infection such as H. pylori can cause gastric ulcers. What does the nurse tell the client about this organism? It causes direct damage to the gastric mucosa. It produces an enzyme that alters the pH of the gastric environment. It reduces the function of the pyloric sphincter, causing reflux. It secretes acid that reduces the integrity of the mucosal barrier

H. pylori secretes urease, which produces ammonia, causing the gastric environment to become alkaline. This causes the release of hydrogen ions and increased acid, which causes mucosal damage. The organism does not damage the mucosa directly or secrete acid. It does not affect pyloric sphincter function.

A client has been recently diagnosed with gastric cancer. What signs and symptoms suggest that the cancer is at an advanced stage? Select all that apply. Indigestion Nausea and vomiting Retrosternal pain Feeling of fullness Enlarged lymph nodes Iron deficiency anemia

In advanced gastric cancer, nausea and vomiting is often present and the lymph nodes may be enlarged. Vomiting may occur due to excessive dilation or thickening of the stomach wall, or may be due to pyloric obstruction. Lymph node enlargement is due to metastasis. Iron deficiency anemia is also a sign of advanced gastric cancer that may be due to the reduction of iron or vitamin B12 absorption. Indigestion, retrosternal pain, and a feeling of fullness are symptoms of early gastric cancer.

The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? Bismuth subsalicylate (Pepto-Bismol) Magnesium hydroxide (Maalox) Metronidazole (Flagyl) Misoprostol (Cytotec)

Misoprostol is a prostaglandin analogue that protects against NSAID-induced ulcers. Bismuth subsalicylate is an antidiarrheal drug that contains salicylates, which can cause bleeding and should be avoided in clients who have peptic ulcer disease (PUD). Magnesium hydroxide is an antacid that may be used to neutralize stomach secretions, but is not used specifically to help prevent NSAID-induced ulcers. Metronidazole is an antimicrobial agent used to treat Helicobacter pylori infection.

The nurse is performing a health history on a client who is newly diagnosed with peptic ulcer disease (PUD). Which condition in the client's history prompts the nurse to question the client further? Cardiovascular disease Hyperlipidemia Osteoarthritis Urinary tract infections

Nonsteroidal anti-inflammatory drugs are a major cause of PUD and are often used by clients who have arthritis; a report of osteoarthritis should prompt the nurse to explore types of treatments the client is using. Cardiovascular disease, hyperlipidemia, and urinary tract infections do not predispose clients to PUD.

A client with a duodenal ulcer receives an order for pantoprazole (Protonix) tablets. The client has a small-bore nasogastric (NG) tube. Which action by the nurse is appropriate? Contact the provider to discuss giving omeprazole or lansoprazole instead. Crush the tablet and dissolve in solution to give through the NG tube. Dissolve the tablet in orange juice and administer through a large-bore NG tube. Request an order for an intravenous proton-pump inhibitor medication.

Pantoprazole should not be crushed before administration, since it is designed to dissolve after passing through the stomach. Omeprazole and lansoprazole may be dissolved and given through any size NG tube. If oral medications cannot be used, an intravenous medication may be ordered.

The nurse is caring for a client with peptic ulcer disease (PUD). What signs and symptoms in the client suggest a surgical emergency? Select all that apply. Black, tarry stool Vomiting of bright red or coffee-ground blood Sudden, sharp pain in the mid epigastrium Tender, rigid, board-like abdomen Assuming the knee-chest position

Perforation of a peptic ulcer is a life-threatening surgical emergency. Perforation causes a sudden, sharp pain in the mid epigastric region. The client becomes apprehensive and the abdomen becomes tender, rigid, and board-like. To decrease the tension of the abdominal muscles, the client usually assumes a knee-chest position. Black, tarry stool or melena and vomiting blood (hematemesis) are common symptoms of PUD, but they do not indicate a surgical emergency.

The nurse is assisting with an esophagogastroduodenoscopy (EGD) procedure on a client who has symptoms of gastritis. The provider collects tissue samples and will test for H. pylori infection using which diagnostic test? Cytologic examination IgG or IgM testing pH measurement Rapid urease testing

Rapid urease testing may be done on tissue samples collected during an EGD to detect H. pylori infection. Cytologic examination is used to detect cancer cells. IgG or IgM H. pylori antibody tests are blood tests to diagnose infection. pH measurement is used to evaluate acid in the upper gastrointestinal tract.

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? Retape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. Document instructions for a client with chronic gastritis about how to use "triple therapy." Assess the gag reflex for a client who has arrived from the postanesthesia care unit (PACU) after a laparoscopic gastrectomy.

Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN. Retaping the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by the RN. Assessment and documenting instructions about how to use triple therapy are nursing functions that should be done by the RN.

The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a need for further teaching? "I need to avoid drinking coffee in the morning when I get to work." "I will not need to take vitamin B12 shots for the rest of my life." "I should avoid alcohol and tobacco." "I should eat small meals about six times a day."

The client should not eat six small meals daily as no evidence supports the theory that eating six meals daily promotes healing of the ulcer. This practice may actually stimulate gastric acid secretion. The client with chronic gastritis should avoid alcohol and tobacco. The client should eliminate caffeine from the diet. The client will need to take vitamin B12 shots only if he or she has pernicious anemia.

Which is the priority nursing action for the client with a stress ulcer? Evaluating heart rate and blood pressure Maintaining a calm, stress-free environment Monitoring and treating gastric pain Preventing nausea and vomiting

The main manifestation of acute stress ulcers is bleeding caused by gastric erosion. The nurse should monitor for signs of bleeding, including heart rate and blood pressure. Stress ulcers are triggered by acute medical crises, trauma, and anxiety, but monitoring for bleeding is more important. Monitoring and treating pain, and preventing nausea and vomiting are not priority actions.

A client with a nasogastric (NG) tube in place to help treat a gastric ulcer develops severe epigastric pain, and the nurse notes a rigid, boardlike abdomen. The nurse notifies the provider of this condition. Which subsequent action is correct? Check for placement of the NG tube. Irrigate the NG tube with saline solution. Maintain nasogastric suction. Withdraw the NG tube immediately.

This client is exhibiting signs of perforation. The nurse should maintain NG tube suction only to drain gastric secretions and prevent further peritoneal spillage. Unless there is reason to suspect incorrect placement, checking the placement of the tube is not the next action. The NG tube should not be irrigated in this instance, and it should not be withdrawn unless respiratory changes occur.

Which client assessment data are correlated with a diagnosis of chronic gastritis? Hematemesis Gastric hemorrhage Frequent use of corticosteroids Treatment with radiation therapy

Treatment with radiation therapy is known to be associated with the development of chronic gastritis. Gastric hemorrhage is a symptom of acute gastritis. Corticosteroid use and hematemesis are also more likely to be signs of acute gastritis.