CH 40 Management of Patients with Gastric and Duodenal Disorders
The nurse is creating a discharge plan of care for a client with a peptic ulcer. The nurse tells the client to avoid A) decaffeinated coffee. B)acetaminophen. C) octreotide. D) skim milk.
A
The nurse is preparing a teaching tool about delayed release proton pump inhibitors used to treat duodenal ulcer disease caused by H. pylori. Which statement will the nurse include that would apply to most types of proton pump inhibitor prescribed to treat this condition? A) The medication is to be swallowed whole and taken before meals B) Abdominal pain and abnormal liver function tests are expected effects C) May cause diarrhea and hyperglycemia D) Interferes with the metabolism of digoxin, iron, and warfarin
A
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience A) pain 2 to 3 hours after a meal. B) vomiting. C) weight loss. D) hemorrhage.
A
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) Systemic infection B) Peptic ulcers C) Pernicious anemia D) Colostomy
B
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. A) "You may be prescribed H2-receptor antagonists for up to 1 year." B) "Be sure to take antacids with meals." C) "Continue to take antacids even if your symptoms subside." D) "The antacids will make you sleepy, so do not operate machinery while taking them." E) "You may take antacids with other medications."
C and A
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) A normal reaction to surgery D) Peritonitis
A
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 sectioned portion of the stomach is joined to the jejunum. B) A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. 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.
B
The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction between gastric and duodenal ulcers. A) Patient's age B) Amount of hydrochloric acid (HCL) secretion in the stomach C) Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) D) Presence of H. pylori
B
The nurse visits the home of a client recovering from acute gastritis. Which observation indicates that teaching about the disorder was effective? A) Extinguished cigarettes in an ashtray B) Medications placed in a pillbox C) Tomato sauce simmering on the stove D) Cup of caffeinated coffee on the kitchen table
B
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) Place the client in the high-Fowler's position. B) Assess the client's abdomen and vital signs. C) Notify the health care provider. D) Irrigate the client's NG tube.
B
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) Penetration B) Perforation C) Hemorrhage D) Pyloric obstruction
C
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? A) Provide a dose of a proton pump inhibitor. B) Encourage the client to drink a warm beverage. C) Notify the primary health care provider. D) Discuss the types of foods the client has been eating.
C
A client with recurrent peptic ulcer disease asks, "How long do I have to take the medication?" Which response will the nurse make? A) "Prophylactically for now." B) "One month or so." C) "Until the prescription is gone." D) "For the rest of your life."
A
A client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make? A) "It helps propel food from the stomach into the duodenum." B) "It improves digestion in the stomach." C) "It enhances the function of the pyloric sphincter." D) "It aids in the healing of the stomach lining."
D
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) Gastric secretion study C) Stool antigen test D) Endoscopy
D
Which medication is classified as a histamine-2 receptor antagonist? A) Metronidazole B) Lansoprazole C) Esomeprazole D) Famotidine
D
Which ulcer is associated with extensive burn injury? A) Cushing ulcer B) Peptic ulcer C) Duodenal ulcer D) Curling ulcer
D
A nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. Based on the client's assessment, what will the nurse suspect? A) Dumping syndrome B) Peritonitis C) A normal reaction to surgery D) Dehiscence of the surgical wound
A
Which of the following is the most successful treatment for gastric cancer? A) Removal of the tumor B) Chemotherapy C) Radiation D) Palliation
A
A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety? Select all that apply. A) Offer information about relaxation methods. B) Help identify the client's current stressors. C) Inform the client the medication will solve the problem. D) Discuss potential coping techniques with the client. E) Interact with the client in a relaxed manner.
A, B, D, and E
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) Cimetidine C) Famotidine D) Esomeprazole E) Lansoprazole
A, B, and C
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? A) Clay-colored B) Black and tarry C) Coffee-ground-like D) Bright red
B
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? A) Celiac disease B) Dumping syndrome C) Bile reflux D) Gastric outlet obstruction
B
A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? A) 4 to 6 days B) 15 to 20 days C) 7 to 9 days D) 10 to 14 days
B
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) Gastric cancer B) Gastric ulcer C) Acute gastritis D) Duodenal ulcer
C
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) Provides much needed rest B) Removes tension on internal suture line C) Slows gastric emptying D) Allows for better absorption of vitamin B12
C
A client with peptic ulcer disease asks for pain medication. Which response will the nurse make? A) "I will ask the health care provider to prescribe pain medication." B) "Using pain medication is what caused the ulcer to develop." C) "The medications for the ulcer will reduce the pain." D) "Eating more food will help reduce the pain."
C
A client with peptic ulcer disease has a blood pressure of 88/40 mm Hg, dizziness, and nausea. Which complication will the nurse suspect is occurring with this client? A) Medication adverse effects B) Allergic response to the medication C) Bleeding from the ulcer D) Evidence of ulcer healing
C
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) A reaction to the medication given for the ulcer B) Gastric penetration C) Ineffective treatment for the peptic ulcer D) Perforation of the peptic ulcer
D
The nurse is caring for a client with chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? A) Vitamin E B) Vitamin A C) Vitamin C D) Vitamin B12
D
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) Pancreas B) Liver C) Lungs D) Bladder E) Duodenum
A, B, and E
A client is admitted with a new onset of pyloric obstruction. What client symptoms should the nurse anticipate? Select all that apply. A) Anorexia B) Weight loss C) Nausea and vomiting D) Epigastric fullness E) Diarrhea
A, C, and D
Which is a true statement regarding gastric cancer? A) The prognosis for gastric cancer is good. B) Most clients are asymptomatic during the early stage of the disease. C) Women have a higher incidence of gastric cancer. D) Most cases are discovered before metastasis.
B
A nursing student is caring for a client with gastritis. Which of the following would the student recognize as a common cause of gastritis? Choose all that apply. A) Participation in highly competitive sports B) Ingestion of strong acids C) Overuse of aspirin D) Irritating foods E) DASH diet
B, C, and D
A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: A) drink liquids only with meals. B) drink liquids only between meals. C) restrict fluid intake to 1 qt (1,000 ml)/day. D) don't drink liquids 2 hours before meals.
B
A nurse is teaching a client who has experienced an episode of acute gastritis. The nurse knows further education is necessary when the client makes which statement? A) "I should limit alcohol intake, at least until symptoms subside." B) "My appetite should come back tomorrow." C) "I should feel better in about 24 to 36 hours." D) "Once I can eat again, I should stick with bland foods."
B
Which medication classification represents a proton (gastric acid) pump inhibitor? A) Metronidazole B) Famotidine C) Omeprazole D) Sucralfate
C
Which of the following appears to be a significant factor in the development of gastric cancer? A) Age B) Ethnicity C) Diet D) Gender
C
Which of the following clients is at highest risk for peptic ulcer disease? A) Client with blood type AB B) Client with blood type B C) Client with blood type O D) Client with blood type A
C
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 is a hereditary disease." B) "It is probably your nerves." C) "You may have ingested some irritating foods." D) "It can be caused by ingestion of strong acids." E) "Is it possible that you are overusing aspirin."
C, D, and E
A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client? A) Take the medication 2 hours before or after other medications B) Ensure adequate potassium intake during therapy C) Blood levels will be evaluated after 1 week D) Take the medication at bedtime to accommodate sedative effects
A
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? A) "It might cause a metallic taste in my mouth." B) "I can have an alcoholic drink in the evenings." C) "My appetite may increase while taking this medication." D) "I can take this medication with my blood thinner."
A
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) "You will not experience GI upset while taking this medication." C) "Be sure to wear sunscreen while taking this medicine." D) "Do not drive when taking this medication."
C
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) Bradycardia B) Hypertension C) Hematemesis D) Polyuria
C
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) Constipation C) Awakening in pain D) Hemorrhage
C
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) "I should take these medications only when I have pain from my ulcer." B) "My ulcer will heal because these medications will kill the bacteria." C) "These medications will coat the ulcer and decrease the acid production in my stomach." D) "The medications will kill the bacteria and stop the acid production."
D
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? A) "The pain stopped so I stopped taking the medications." B) "I think the soda that I drank irritated my stomach." C) "I felt better but then just got really nauseated and threw up." D) "I only ate dinner yesterday and it gave me an upset stomach."
A
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? A) "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." B) "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." C) "Caffeine increases the fluid volume in your system, which irritates your digestive organs." D) "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems."
A
A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: A) alcohol abuse and smoking. B) alcohol abuse and a history of acute renal failure. C) a history of hemorrhoids and smoking. D) a sedentary lifestyle and smoking.
A
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) Omeprazole B) Famotidine C) Cimetidine D) Nizatidine
A
Clients with Type O blood are at higher risk for which of the following GI disorders? A) Duodenal ulcers B) Gastric cancer C) Esophageal varices D) Diverticulitis
A
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? A) Eat several small meals daily spaced at equal intervals. B) Choose foods that are high in simple carbohydrates. C) Drink a minimum of 12 ounces of fluid with each meal. D) Sit upright when eating and for 30 minutes afterward.
A
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 can buy whatever antacids are on sale because they all have the same effect." D) "I have learned some relaxation strategies that decrease my stress."
D
