Chapter 33
d
7. The nurse is caring for a client with chronic atrophic gastritis. When taking an admission history, the nurse would anticipate a history of a) cardiac disease b) emphysema. c) intestinal parasites. d) pernicious anemia.
b
A 44-year-old man admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take? a) Irrigate the NG tube. b) Check the vital signs. c) Give the ordered antacid. d) Elevate the foot of the bed.
c
A 46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed? a) I take antacids between meals and at bedtime each night. b) I sleep with the head of the bed elevated on 4-inch blocks. c) I eat small meals during the day and have a bedtime snack. d) I quit smoking several years ago, but I still chew a lot of gum.
a
A 50-year-old patient who underwent a gastroduodenostomy (Billroth I) earlier today complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The highest priority action by the nurse is to a) contact the surgeon. b) irrigate the NG tube. c) monitor the NG drainage. d) administer the prescribed morphine.
d
A 62-year-old man patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about a) substitution of acetaminophen (Tylenol) for the NSAID. b) use of enteric-coated NSAIDs to reduce gastric irritation. c) reasons for using corticosteroids to treat the rheumatoid arthritis. d) misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.
d
A client asks the nurse about the prescribed diet after gastric surgery. The nurse clarifies that a high-protein, high-fat, low-carbohydrate, dry diet is the best choice after gastric surgery because this diet. a) does not cause diarrhea. b) does not dilate the stomach. c) is quickly digested. d) is slow to leave the stomach.
d
A client tells the nurse that the health-care provider will remove 75% of the stomach and leave a narrow tube. Which procedure does this describe? a) Adjustable gastric banding b) Roux-en-Y c) Gastric plication d) Sleeve gastrectomy
a,b,c,d,e
A client with a duodenal ulcer complains of a sudden onset of severe pain. In which order should the nurse perform the following activities? (select all that apply) a) Assess the patency of the patients IV line. b) Call the physician. c) Have the nurses aid obtain a set of vital signs. d) Perform a complete abdominal examination. e) Prepare to administer IV pain medication.
b
A family member of a 28-year-old patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will a) decrease nausea and vomiting. b) inhibit development of stress ulcers. c) lower the risk for H. pylori infection. d) prevent aspiration of gastric contents.
c
A nurse is assessing a client with a history of a duodenal ulcer. Which finding is consistent with the nurses knowledge about this condition? a) Certain types of food increase gastric distress. b) Eating nearly any food causes pain. c) Pain may awaken the client in the middle of the night. d) The client complains of spitting up blood.
a,c,d
A nurse is teaching health promotion measures to a support group for clients who are at high risk for gastric cancer. Important health promotion measures to advise the clients include (select all that apply) a) avoiding alcohol. b) eating a diet high in nitrites. c) limiting salted fish and pickled foods. d) quitting smoking.
c) low-fat diet
A patient had a gastrectomy 2 months ago and is being seen in the clinic for greasy stools and frequent bowel movements. After the patient's surgical recovery and current eating habits are identified, which type of diet would be most appropriate for the nurse to teach the patient to use? a) soft diet b) high-carb diet c) low-fat diet d) pureed diet
a
A patient is admitted with chronic gastritis type B. Which of the following signs and symptoms would the nurse anticipate finding? a) anorexia b) dysphagia c) diarrhea d) feeling of fullness
c
A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? a) The patient is experiencing intermittent waves of nausea. b) The patient complains of 7/10 (0 to 10 scale) abdominal pain. c) The patient has absent breath sounds in the left anterior chest. d) The patient has hypoactive bowel sounds in all four quadrants.
b, d, e
An asymptomatic patient is admitted with gastric bleeding. For which of the following signs or symptoms of severe gastric bleeding should the nurse monitor? (Select all that apply) a) restlessness b) diaphoresis c) bounding pulse d) hypotension e) confusion
c
An older male client with chronic gastritis asks the nurse, Do you think Ill get gastric cancer? The most accurate response by the nurse is a) As long as the chronic gastritis is diagnosed early, there is little risk of gastric cancer. b) Chronic gastritis is not associated with the development of gastric cancer in men over 40. c) Individual predictions are not possible, but chronic gastritis is associated with the development of gastric cancer. d) Women with chronic gastritis are more likely to get gastric cancer than men who have chronic gastritis.
c
At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to a) increase the amount of fluid with meals. b) eat foods that are higher in carbohydrates. c) lie down for about 30 minutes after eating. d) drink sugared fluids or eat candy after meals.
pernicious anemia
Individuals with Type A Chronic Gastritis, there is difficulty absorbing vitamin B12 which leads to ____________________.
b
Priority nursing actions to achieve critical goals in the postoperative period for a client who has just returned from a Billroth II procedure should include a) encouraging oral intake. b) ensuring frequent coughing and deep breathing. c) irrigating the clients NG tube every hour. d) maintaining the client in the semi-Fowler position.
d
Ranitidine (Zantac) is prescribed for a client with a gastric ulcer. The statement that best indicates to the nurse that the client understands the action of this drug is a) I will take this medication at bedtime to relieve pain. b) Ranitidine will activate protective mucous barriers. c) Stomach acids are neutralized by this medication. d) This drug reduces the acid in my stomach.
Type B chronic gastritis
Signs and symptoms including poor appetite, heartburn after eating, belching, a sour taste in the mouth, and nausea and vomiting are characteristics of ________________________.
a
The client with chronic gastritis is experiencing abdominal pain. In order to provide the client the fastest relief, the nurse plans to administer a) aluminum hydroxide with magnesium trisilicate (Gaviscon). b) clarithromycin (Biaxin). c. metronidazole (Flagyl). d) omeprazole (Prilosec).
d
The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication a) reduces gastroesophageal reflux by increasing the rate of gastric emptying. b) neutralizes stomach acid and provides relief of symptoms in a few minutes. c) coats and protects the lining of the stomach and esophagus from gastric acid. d) treats gastroesophageal reflux disease by decreasing stomach acid production.
c
The nurse is caring for a client receiving treatment for esophageal cancer. Which intervention will the nurse expect to implement? a) Encourage increased fluid intake b) Initiate parenteral nutrition c) Administer analgesics as prescribed d) Insert a temporary nasogastric (NG) tube
d
The nurse is caring for a client who underwent bariatric surgery. Which interventions will the nurse implement? a) Place the client in supine position b) Encourage the client to drink 240 ml of liquid at a time c) Instruct the client to have reconstructive surgery 6 mo after the surgery d) Discuss with the client a weight loss goal of 1 to 2 pounds weekly
c
The nurse is caring for a client who underwent partial removal of the stomach. Which clinical manifestation requires notification of the health-care provider (HCP)? a) Mild headache b) Discomfort of the incision site c) Sore tongue d) Light pink drainage
d
The nurse is caring for a client with a duodenal ulcer. Which symptom describes this type of ulcer? a) Pain made worse by food b) Malnourishment c) High-left epigastric pain d) Nausea and vomiting
a,c,d,e
The nurse is caring for a client with a late-stage oral cancer. Which clinical manifestations can the nurse expect to find? Select all that apply. a) Painless, tender ulcers b) Diarrhea c) Difficulty chewing d) Dysphagia e) Swollen cervical lymph glands
d
The nurse is caring for a client with dumping syndrome. Which clinical manifestation can the nurse expect to find? a) Constipation b) Bradycardia c) Dry skin d) Dizziness
a,c,e
The nurse is caring for a client with gastric bleeding. After notifying the health-care provider, which interventions can the nurse expect to implement? Select all that apply. a) Prepare the client for a complete blood count (CBC) b) Place the client in prone position c) Keep the client nothing by mouth (NPO) d) Monitor client's vital signs e) Insert a nasogastric (NG) tube
c)
The nurse is collecting data on a patient who recently returned from surgery after fundoplication. Which symptom is essential to report to the healthcare provider? a) nausea b) pain rated as 4 out of 10 c) dysphagia d) thirst
d
The nurse is monitoring a client who has had gastric surgery for manifestations of dumping syndrome. The nurse should be particularly watchful for the early manifestation of a) hypertension. b) pain. c) tenesmus. d) vertigo.
c
The nurse is performing a stool test for occult blood. Which substance can contribute to a false-positive result? a) Antibiotics b) Ingestion of carrots c) Anticoagulants d) Ingestion of apples
a
The nurse is teaching a client about a barium swallow. Which statement made by the client indicates an understanding regarding the procedure? a) "I cannot smoke the morning of the procedure." b) "I will have nothing by mouth 24 hours prior to the procedure." c) "I will limit my fluid intake before and after the procedure." d) "I may experience diarrhea after the test."
a
The nurse will anticipate preparing a 71-year-old female patient who is vomiting coffee-ground emesis for a) endoscopy. b) angiography. c) barium studies. d) gastric analysis.
d
The nurse will anticipate teaching a patient experiencing frequent heartburn about a) a barium swallow. b) radionuclide tests. c) endoscopy procedures. d) proton pump inhibitors.
Type A chronic gastritis
There is usually not enough intrinsic factor secreted from the stomach cells in those with ________________________.
Duodenal
These are all symptoms of what type of ulcer?
Gastric
These are all symptoms of what type of ulcer?
autoimmune gastritis
Type A chronic gastritis is often referred to as _______________________.
fundus
Type A chronic gastritis occurs in the ___________________.
antrum; pylorus
Type B chronic gastritis affects the _________________ and ________________ of the stomach.
H. pylori bacterial infection
Type B chronic gastritis is associated with ______________________________________.
teach patient to apply topical tetracycline several times a day to the sore
What nursing action should the nurse implement for a patient with apthous stomatitis (canker sores)?
a
Which action should the nurse in the emergency department anticipate for a 23-year-old patient who has had several episodes of bloody diarrhea? a) Obtain a stool specimen for culture. b) Administer antidiarrheal medication. c) Provide teaching about antibiotic therapy. d) Teach about adverse effects of acetaminophen (Tylenol).
b
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)? a) You will need to remain on a bland diet. b) Avoid foods that cause pain after you eat them. c) High-protein foods are least likely to cause you pain. d) You should avoid eating any raw fruits and vegetables.
b
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)? a) Ranitidine absorbs the gastric acid. b) Ranitidine decreases gastric acid secretion. c) Ranitidine constricts the blood vessels near the ulcer. d) Ranitidine covers the ulcer with a protective material.
b
Which medications will the nurse teach the patient about whose peptic ulcer disease is associated with Helicobacter pylori? a) Sucralfate (Carafate), nystatin (Mycostatin), and bismuth (Pepto-Bismol) b) Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) c) Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix) d) Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan)
b
Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy? a) Notify the doctor about bloody nasogastric (NG) drainage. b) Elevate the head of the bed to at least 30 degrees. c) Reposition the NG tube if drainage stops. d) Start oral fluids when the patient has active bowel sounds.
a) painless ulcer
Which of the following does the nurse understand is a sign or symptom of oral cancer? a) painless ulcer b) white painful ulcers c) feeling of fullness d) heartburn
a) gastrectomy
Which of the following surgical procedures is the most likely treatment for a patient with gastric cancer? a) gastrectomy b) gastric stapling c) gastroplasty d) gastrorrhaphy
a
Which patient statement indicates that the nurses teaching following a gastroduodenostomy has been effective? a) Vitamin supplements may prevent anemia. b) Persistent heartburn is common after surgery. c) I will try to drink more liquids with my meals. d) I will need to choose high carbohydrate foods.
b) esophageal dilation
Which procedure is done palliatively for the dysphagia that occurs in inoperable esophageal cancer? a) gastrectomy b) esophageal dilation c) radial neck dissection d) modified neck dissection
