CH 58

The nurse is teaching the client about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the client indicates a need for further teaching? a. "Sweetened fruit juice beverages will need to be avoided." b. "Ice cream can be eaten in moderation." c. "I cannot drink alcohol at all." d. "It is okay to have a serving of sugar-free pudding."

"Ice cream can be eaten in moderation." Milk products such as ice cream must be eliminated from the diet of the client with dumping syndrome.

The client with peptic ulcer disease (PUD) asks the nurse whether a maternal history of ovarian cancer will cause the client to develop gastric cancer. What is the nurse's best response? a. "Yes, it is known that a family history of ovarian cancer will cause someone to develop gastric cancer." b. "If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing." c. "Have you spoken to your physician about your concerns?" d. "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food."

"If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing."

The nurse is teaching the client with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? a. "Nizatidine (Axid) needs to be taken three times a day to be effective." b. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." c. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." d, "Omeprazole (Prilosec) should be swallowed whole and not crushed."

"Nizatidine (Axid) needs to be taken three times a day to be effective." Nizatidine (Axid) is most effective if administered twice daily.

The client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? "Pain control is a major component of the care provided by hospice and its staff members." "What has your doctor told you about participating in hospice? "I can speak to your physician about requesting adequate pain medication." "You don't want to become too dependent on pain medication and become an addict."

"Pain control is a major component of the care provided by hospice and its staff members."

The nurse has placed a nasogastric (NG) tube in the client who has overdosed to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? a. "Saline goes down the tube to help clean out your stomach." b. "Medicine goes down the tube to help clean out your stomach." c. "The doctor requested the tube to be placed just in case it was needed. d. "We'll start feeding you through it once your stomach is cleaned out."

"Saline goes down the tube to help clean out your stomach."

The client is an older woman diagnosed with Zollinger-Ellison syndrome. Which statement made by the client's family demonstrates correct understanding of the disorder? a. "She may have to be treated with chemotherapy drugs." b. "This is going to be a chronic problem that cannot be cured." c. "At least this is not an inherited ailment." d. "Thank goodness she won't have to undergo surgery."

"She may have to be treated with chemotherapy drugs." The client may undergo treatment with chemotherapeutic agents to reduce the tumor before further treatment can commence.

The nurse is teaching the client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates correct understanding of the nurse's instruction? "It is okay to continue to drink coffee in the morning when I get to work." "I will need to take vitamin B12 shots for the rest of my life." "Ibuprofen (Advil, Motrin, others) can be taken for my headaches instead of aspirin." "Small meals should be eaten about six times a day."

"Small meals should be eaten about six times a day."

The client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? "No, they probably won't be useful. You should use only prescription medications in your treatment plan." "These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen." "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

"These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen."

The client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." "What has your doctor told you about how your gastritis developed?" "Yes, a familial tendency to inherit Crohn's disease as well as gastritis has been reported. Have your other family members been tested for Crohn's disease?''

"We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop."

Your patient has adenocarcinoma, and just arrived on your unit from surgery. Which intervention do you intervene the graduate nurse to help? A.irrigate the nasogastric tube B. Giving small frequent meals C. Teach about postoperative complications D. Teach proper administration of antacids

...

What are common complications of peptic ulcer disease? A. Hemorrhage B. Perforation C. Pyloric obstruction D. Nuccal rigidity E. Intractable disease

A, B, C, E

Which words describe gastritis? Select all that apply. A. Erosive B. Nonerosive C. Acid reflux D. Inflamed Gastric mucosa

A, B, D

Which of the following are types of peptic ulcers? A. Stress ulcers B. Duodenal ulcers C. Liver ulcers D. Ulcerative collitis E. Gastric ulcers

A, B, E

Symptoms of acute gastritis include which of the following. Select all that apply. A. Mild to severe epigastric pain B. Dysuria C. Nausea and vomiting D. Abdominal tenderness and bloating E. Acid reflux F. Hematemesis

A, C, D, F

Patchy, diffuse inflammation of the mucosal lining of the stomach, resulting in thinning and atrophy of the walls and lining of the stomach. A. Chronic gastritis B. Acute gastritis C. Ulcerative collitis D. Helicobacter pylori infection

A. Chronic gastritis

What is the gold standard for diagnosing gastritis? A. Esophagogastroduodenoscopy B. Endoscopy C. Pyloroplasty D. Stool analysis

A. Esophagogastroduodenoscopy

Type B gastritis is more common and caused by A. H. Pylori B. Autoimmune C. Chronic gastritis D. Acute gastritis

A. H. Pylori

Mucosal legion of the stomach or duodenum is A. Peptic ulcer B. Acute gastritis C. Ulcerative colitis D. Gastric cancer

A. Peptic ulcer

The nurse finds a client vomiting coffee ground-type material. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention will be the nurse's first priority? a. Administering an H2 antagonist b. Initiating enteral nutrition c. Administering intravenous (IV) fluids d. Administering antianxiety medication

Administering intravenous (IV) fluids

The client with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 lbs of body weight has been regained. The client is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this client? Explain to the client the importance of drinking the enteral supplements prescribed. Ask the client's family to try to persuade the client to drink the supplements. Inform the client that a nasogastric tube may be necessary if he or she fails to comply. Ask the client if a change in flavor would make the supplement more palatable.

Ask the client if a change in flavor would make the supplement more palatable.

Inflammation of the gastric mucosa of submucosa after exposure to local irritants or other cause is A. Chronic gastritis B. Acute gastritis C. Stomach ulcers D. Ulcerative cirrhosis

B. Acute gastritis

Type A gastritis had been associated with the presence of antibodies to parietal cells and intrinsic factor, therefore, most likely related to A. H. Pylori B. Autoimmune disease C. Chronic gastritis D. Acute gastritis

B. Autoimmune disease

The nurse is monitoring the client with gastric cancer for signs and symptoms of upper GI bleeding. Which change in vital signs is most indicative of bleeding related to cancer? a. Respiratory rate from 24 to 20 breaths/min b. Apical pulse from 80 to 72 beats/min c. Temperature from 98.9° F to 97.9° F d. Blood pressure from 140/90 to 110/70 mm Hg

Blood pressure from 140/90 to 110/70 mm Hg A decrease in blood pressure is the most indicative sign of bleeding.

The nurse and the dietitian are planning sample diet menus for the client who is experiencing dumping syndrome. Which sample meal is best for this client? Chicken salad on whole wheat bread Liver and onions Chicken and rice Cobb salad with buttermilk ranch dressing

Chicken and rice

Rare disease that is manifested by upper gastrointestinal tract ulceration, increased gastric acid secretion, and one or more duodenal or pancreatic tumors, called gastrinoma. A. Gastric cancer B. Acute gastritis C. Chronic gastritis D. Zollinger-Ellison syndrome

D. Zollinger-Ellison syndrome

Inflammation of the gastric mucosa is... A. Localized swelling B. Indigestion C. Heartburn D. Gastritis

Gastritis

The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40, pulse 124, and respiratory rate 26. Which admission request will the nurse implement first? a. Type and crossmatch for 4 units of packed red blood cells. b. Infuse lactated Ringer's solution at 200 mL/hr. c. Give pantoprazole (Protonix) 40 mg IV now and then daily. d. Insert nasogastric tube and connect to low intermittent suction.

Infuse lactated Ringer's solution at 200 mL/hr. The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia.

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

Misoprostol (Cytotec) Misoprostol (Cytotec) is a prostaglandin analogue that protects against NSAID-induced ulcers.

The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which syndrome is most significant in determining whether the client's ulceration is gastric or duodenal in origin? a. Pain occurs 1 1/2 to 3 hours after a meal, usually at night. b. Pain is worsened by the ingestion of food. c. The client has a malnourished appearance. d. The client is a man older than 50 years.

Pain occurs 1 1/2 to 3 hours after a meal, usually at night.

The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request will the nurse implement first? a. Apply antiembolism stockings. b. Place nasogastric (NG) tube, and connect to suction c. Insert an indwelling catheter, and check output hourly. d. Give famotidine (Pepcid) 20 mg IV every 12 hours.

Place nasogastric (NG) tube, and connect to suction to decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis.

The client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? a. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician b. Asking the physician for a referral for home health services to assist with dressing changes c. Asking the spouse whether other family members could be taught how to change the dressing d. Trying to determine specific concerns that the spouse has regarding dressing changes

Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician

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

Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis Reinforcement of teaching done by the nurse is within the scope of practice for an LPN/LVN.

The client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? Schedule of the client's follow-up examinations and x-ray assessments Information on family members' progress in learning how to perform dressing changes Copy of the diet plan prepared for the client by the hospital dietitian Detailed account of what occurred during the client's surgical procedure

Schedule of the client's follow-up examinations and x-ray assessments

The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? a. Starting a large-bore intravenous (IV) b.Administering intravenous (IV) pain medication c.Preparing equipment for intubation d. Monitoring the client's anxiety level

Starting a large-bore intravenous (IV)

The client is exhibiting symptoms of gastritis. The nurse is assessing the client to determine whether the form of gastritis being experienced is acute or chronic. Which data are correlated with a diagnosis of chronic gastritis? a Anorexia, nausea, and vomiting b. Frequent use of corticosteroids c. Hematemesis and anorexia d. Treatment with radiation therapy

Treatment with radiation therapy

True or false. Acute gastritis healing is spontaneous, usually occurring within a few days.

True

The nurse working during the day shift on the medical unit has just received report. Which client will the nurse plan to assess first? a. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy b. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal c. Middle-aged client with Zollinger-Ellison syndrome who needs to receive omeprazole (Prilosec) before breakfast d. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy. This client is experiencing symptoms of acute gastric dilation, which can disrupt the suture line. The surgeon should be notified immediately because the nasogastric tube may need irrigation or repositioning.