Exam 5
Which medication causes gastritis?
Aspirin
Surgery is scheduled for a patient with a bowel obstruction. The nurse plans to include which prescribed measure in the preoperative preparation of this patient?
Administration of IV antiemetics
The nurse provides education for a group of nursing students about inguinal hernias in men. Which information does the nurse include?
An inguinal hernia occurs at the point of weakness in the abdominal wall where the spermatic cord emerges.
Which treatment will the nurse explain to the patient with oral candidiasis?
Nystatin oral suspension
Which ostomy surgery is indicated in the figure?
loop ostomy
The nurse is teaching about home care to a patient with gastrointestinal reflux disease (GERD). Which statement made by the patient indicates the need for further teaching?
"I should lie down for two to three hours after eating."
The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point would the nurse provide to the patient?
"It would likely be beneficial for you to eliminate drinking alcohol."
A patient who has cholecystitis reports nausea, vomiting, and acute upper quadrant pain radiating to the back, rated as a 10 on a 1 to 10 pain scale. Which patient problem would the nurse identify as the highest priority?
Acute Pain
A patient who has lip lesions and painful ulcers works outdoors and reports high levels of emotional stress. Which medication would the nurse expect to be prescribed?
Acyclovir
The nurse expects that which medication will be prescribed for a female patient with irritable bowel syndrome with diarrhea (IBS-D)?
Alosetron Rationale Alosetron is used to treat IBS-D in women. Linaclotide is used in the treatment of IBS with constipation (IBS-C) in men and women. Lubiprostone is the medication used in the treatment IBS-C in women. Trimethobenzamide is used in the treatment of nausea and vomiting.
A patient reports periumbilical pain that increases after coughing and sneezing. The patient prefers to lie still with the right leg flexed. Which condition does the nurse suspect?
Appendicitis
Which interventions should the nurse perform to relieve stomatitis for a patient experiencing severe side effects of chemotherapy? Select all that apply.
Apply topical anesthetics. Encourage nutritional supplements. Discourage the use of irritants like tobacco.
A nurse is teaching a patient with gastroesophageal reflux disease (GERD) who is obese about measures to prevent complications. Which instructions would the nurse give? Select all that apply.
Avoid tea and coffee. Maintain a low-fat diet. Avoid smoking cigarettes.
Which complication would the nurse expect in a patient with gastroesophageal reflux disease (GERD) who has been taking dexlansoprazole for one year?
Bone fracture
A patient with chronic constipation is at risk for which complications? Select all that apply.
Diverticulosis Rectal mucosal ulcers Hemorrhoids
A patient reports gastric distress that occurs two to five hours after meals, with "burning" and "cramping" pain just below the xiphoid process. Which disorder would the nurse suspect that the patient may have?
Duodenal ulcer
The nurse reviews the dietary instructions that have been prepared by another health care provider for management of irritable bowel syndrome (IBS). The nurse identifies that which statement needs correction?
Eat cabbage.
The nurse is assessing a patient who reports difficulty with bowel movements. The nurse suspects that the patient has external hemorrhoids based on which assessment findings? Select all that apply.
Edema Burning Anal pruritus
After a patient undergoes a surgical repair of a fistula, which education does the nurse provide related to preventing complications related to the procedure?
Ensure that she does not place stress on the repaired area. Rationale: Following surgical repair of a fistula, the patient should avoid placing stress on the repaired region. Douching is contraindicated, and pessaries are used to treat prolapses, not fistulas. Normal activity is not commonly resumed until significant healing has occurred.
Which dietary substance would the nurse recommend limiting for a patient with acute cholecystitis?
Fat
Which symptom would the nurse expect to be relieved after a patient who has gastroesophageal reflux disease (GERD) takes an oral dose of aluminum hydroxide/magnesium hydroxide?
Heartburn
A patient tells the nurse, "I have been constipated and have to strain to have a bowel movement. When cleaning after defecation, I notice blood on the toilet tissue." Which does the nurse suspect as the source of bleeding?
Hemorrhoids
A male patient is being treated for irritable bowel syndrome with constipation (IBS-C). The nurse anticipates a prescription for which medication?
Linaclotide Rationale Linaclotide is used to treat IBS-C in men or women. Alosetron and loperamide are medications used in the treatment of irritable bowel syndrome with diarrhea (IBS-D). Lubiprostone is used in the treatment of IBS-C in women.
A hospitalized patient reports abdominal pain, nausea, and vomiting. Suspecting a bowel obstruction, for which primary acid-base imbalance would the nurse plan the patient's care, if the obstruction is high in the intestinal tract?
Metabolic alkalosis
The nurse recognizes that parenteral nutrition (PN) may be the only feasible option for patients with which conditions? Select all that apply.
Nonfunctioning gastrointestinal (GI) tract GI obstruction Short bowel syndrome
When assessing a patient with a gastrointestinal disorder, the nurse finds an absence of bowel sounds. The assessment findings are indicative of which condition?
Paralytic ileus
Which action should a nurse take concerning a patient who seeks treatment after searching the Internet and self-diagnosing appendicitis?
Provide appropriate and valid information on appendicitis.
The nurse reviews the medical record of a patient with a possible small bowel obstruction and expects which history findings? Select all that apply.
Rapid onset Frequent, copious vomiting Colicky, cramping, intermittent pain
Which food in the patient's diet would likely facilitate improvement in the condition of cholelithiasis?
Skim milk Rationale Skim milk is rich in calcium and low in fat. Patients with cholelithiasis should consume a diet rich in calcium and fiber and low in fat. Butter, yogurt, and cheese are rich in fats. Fat-rich foods should not be consumed by patients with biliary tract disease such as cholelithiasis or cholecystitis.
The nurse in an outpatient clinic reviews the medical record of a patient who reports mouth pain. The nurse identifies that which finding places the patient at the highest risk for parotitis?
Staphylococcus infection
A patient with atrophic gastritis who has a cobalamin deficiency is at risk for which condition?
Stomach Cancer Rationale Patients with atrophic gastritis will lose parietal cells because of atrophy, which causes pernicious anemia and stomach cancer. Gastric ulcers are caused by risk factors such as bile reflux, smoking, and alcohol abuse. Patients with a history of ulcer disease who use ulcerogenic drugs and anticoagulants tend to develop nonsteroidal-induced gastritis. Upper gastrointestinal bleeding is caused by drug-induced bleeding, esophageal bleeding, and systemic diseases.
To prevent the recurrence of gastritis, which instruction would the nurse provide to the patient?
Stop smoking and do not consume alcoholic beverages.
Which medication for treating gastroesophageal reflux disease (GERD) may cause constipation?
Sucralfate Sucralfate is an antiulcer medication that forms a protective layer and serves as a barrier against acids, bile salts, and stomach enzymes. It causes constipation as a side effect. Misoprostol is a prostaglandin that causes diarrhea. Bethanechol is a cholinergic that causes diarrhea. Esomeprazole is proton pump inhibitor that causes diarrhea.
While assessing the scrotum of a patient, the nurse notes that the left side of the scrotal sac is hanging lower than the right. Which conclusion would the nurse draw from this finding?
The patient is normal.
Which statements would the nurse include when teaching a patient with a body mass index (BMI) of 45 about the potential complications of abdominal surgery caused by obesity? Select all that apply.
The risk of wound infection is higher. Anesthesia administration is more difficult. The risk of a postoperative incisional hernia may be higher.
The nurse finds fever, bleeding ulcers in the mouth, and bad oral odor in a patient with bleeding and painful gums. Which intervention would the nurse expect will be prescribed for this patient?
Topical application of antibiotics Rationale: Painful bleeding gums, anorexia, fever, and bleeding ulcers in the mouth with bad odor indicate Vincent's infection. It is caused by fusiform bacteria called Vincent spirochetes. Topical application of antibiotics is used to treat Vincent's infection. Acyclovir is used in patients with herpes simplex infection. Oral suspension of amphotericin B is used to treat oral candidiasis. In aphthous stomatitis, topical application of corticosteroids is recommended.
Which type of intestinal obstruction is depicted in the figure?
Volvulus Rationale The given figure depicts volvulus, which is an intestinal obstruction that occurs by the bowel twisting around itself. Paralytic ileus is a condition in which bowel sounds and intestinal peristalsis are absent. Pseudopolyps are tongue-like projections into the bowel lumen. Intestinal strangulation is a condition in which the bowel becomes so distended that blood stops flowing, resulting in edema, cyanosis, and gangrene of the bowel.
A patient is diagnosed with irritable bowel syndrome (IBS). The nurse advises the patient to avoid which food item?
Wheat Rationale Dietary intolerances that may contribute to IBS symptoms include gluten and fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs). Examples of oligosaccharides are wheat and rye products. Fish is rich in omega-3 fatty acids. Squash consists of many useful antioxidants and phytonutrients that can help protect the body from damage or the negative effects of stress. Pulses are the edible seeds of plants in the legume family and are rich in proteins.
Which tests might be ordered for patients admitted with symptoms of cholecystitis? Select all that apply.
Abdominal ultrasound Endoscopic retrograde cholangiopancreatography (ERCP) Rationale Abdominal ultrasound and ERCP are commonly ordered for diagnosis of suspected cholecystitis. Stool samples are not generally ordered in instances of cholecystitis. Serum α-fetoprotein is used in the diagnosis of liver cancer, generally coupled with ultrasound. Secretin stimulation tests are used in the diagnosis of chronic pancreatitis.
The nurse provides postoperative care for an older patient with asthma six hours after a hernia repair. Assessment findings include the following: body temperature 103.2°F, pulse 99/min, and BP 100/70 mm Hg. Which is the most effective nursing intervention?
Administer antipyretic drugs around the clock.
Which antacid used in the treatment of gastrointestinal reflux disease (GERD) causes phosphorus depletion with chronic use?
Aluminum hydroxide
A patient with gastroesophageal reflux disease (GERD) is on cimetidine therapy. Which parameter would the nurse monitor?
Bowel sounds Cimetidine is a histamine receptor used in the treatment of peptic ulcer and GERD. Cimetidine decreases gastric motility and causes constipation. Therefore the nurse monitors the patient for any changes in bowel sounds. This may help with early detection of constipation. Cimetidine does not have extrapyramidal side effects and does not cause motor incoordination. Cimetidine does not alter serum calcium or magnesium levels.
A patient who underwent abdominal surgery complains of sweating, weakness, palpitations, and dizziness 20 minutes after a meal. Upon auscultation, the nurse finds the patient to have borborygmi. Which complication would the nurse suspect in the patient?
Dumping syndrome
A patient has been admitted to a medical unit with clinical manifestations of a blockage of the large intestine. The nurse expects a prescription for which diagnostic procedure?
Colonoscopy
The nurse provides discharge education for a patient who underwent inguinal hernia repair surgery. Which statement made by the patient reflects the need for additional teaching?
"I can go back to my job at a moving company in four weeks."
The nurse is giving a patient instructions regarding the management of gastroesophageal reflux disease (GERD). Which statement indicates that further teaching is required?
"I can have warm milk at bedtime but not chocolate milk."
A patient is hospitalized with abdominal pain, nausea, and vomiting. A bowel obstruction is suspected. The nurse expects which assessment findings?
Abdominal distention and high-pitched bowel sounds above the obstruction Rationale Early in the course of intestinal obstruction, the patient's bowel sounds are hyperactive and high-pitched, sometimes referred to as "tinkling," above the level of the obstruction. Associated symptoms include abdominal distention and generalized abdominal pain. Diarrhea would not be present because there is an obstruction preventing stool from passing. As the obstruction becomes complete, bowel sounds decrease and finally disappear.
The nurse is educating a patient about the advantages of acyclovir therapy for herpes infection. Which information would the nurse include? Select all that apply.
Acyclovir shortens the duration of viral shedding. Acyclovir shortens the healing time of genital lesions. Acyclovir reduces the frequency of outbreaks of the lesions.
A colostomy is scheduled for a patient with a bowel obstruction. The nurse expects that which intervention will be included in the patient's preoperative preparation?
Administration of an IV antibiotic Rationale Surgery may involve simply resecting the obstructed segment of bowel and anastomosing the remaining healthy bowel back together. Partial or total colectomy may be done when extensive obstruction or necrosis is present. The initial treatment includes obtaining blood cultures and starting IV antibiotic therapy. Instructions to irrigate the colostomy will be done postoperatively. The patient will be placed on NPO status. Preoperative preparations will also include providing IV fluid therapy with either normal saline or lactated Ringer's solution.
Which medication is likely to be prescribed for a patient reporting coughing, dyspnea, and radiating pain to the back, neck, and jaw?
Aluminum hydroxide Rationale Respiratory symptoms, such as coughing, and dyspnea accompanied with radiating pain to the back, neck, and jaw indicate gastroesophageal reflux disease (GERD). GERD-related chest pain is similar to angina. Antacids such as aluminum hydroxide are used in the treatment of GERD-related chest pain. Nifedipine and isosorbide dinitrate are used in the treatment of achalasia. Prednisone is used in the treatment of eosinophilic esophagitis.
A patient is hospitalized with abdominal pain, rebound tenderness, and muscle rigidity. The patient's assessment findings include a heart rate of 150 beats/minute. The nurse anticipates that the plan of care will include which treatment strategies? Select all that apply.
Antibiotic therapy Nasogastric (NG) suction Rationale Abdominal pain is the most common symptom of peritonitis. Rebound tenderness, muscular rigidity, and spasm are other signs of peritoneal irritation. Abdominal distention, fever, tachycardia, tachypnea, nausea, vomiting, and altered bowel habits may be present. The patient with peritonitis is extremely ill and needs skilled supportive care. The nurse should establish IV access so that replacement fluids lost to the peritoneal cavity can be given and to have access for antibiotic therapy. The patient may need an NG tube to decrease gastric distention and further leakage of bowel contents into the peritoneum. There is not enough information provided to indicate the need for a colectomy. Antimicrobial therapy and biologic and targeted therapy are used to treat inflammatory bowel disease.
A patient with a chronic infection of the pharynx reports ulcers in the mouth and lips with severe pain. Which condition does the nurse suspect?
Aphthous stomatitis Rationale: Mouth and lip ulcers with severe pain due to chronic infection and injury indicate aphthous stomatitis. Excessive salivation and sore mouth due to trauma, pathogens, irritants, liver, and renal diseases characterize stomatitis. Lip and mouth lesions due to prolonged exposure to sunlight and/or emotional stress characterize herpes simplex. Vincent's infection involves painful and bleeding gingivae due to nutritional deficiencies and poor oral hygiene.
The nurse is caring for a patient with peptic ulcer disease. On a follow-up visit, the health care provider identifies spillage of gastric contents into the space between the abdominal cavity and the abdominal wall. Which complication may occur if the condition is untreated?
Bacterial peritonitis
Which items that may aggravate the symptoms of gastroesophageal reflux disease (GERD) would the nurse explain to a patient with that condition? Select all that apply.
Caffeine Chocolate Orange juice Cigarette smoking
Which medication has a side effect of milk-alkali syndrome?
Calcium carbonate
A patient underwent a fistulectomy to treat a vesicovaginal fistula. Which information does the nurse include in the patient's discharge instructions? Select all that apply.
Change perineal pads frequently Cleanse the perineum every four hours Rationale: The nurse's role in the management of a fistula is to keep the perineum clean and hygienic. Hence, the perineum should be cleansed every four hours, and perineal pads should be changed frequently. Keeping the perineum clean helps to reduce inflammation and edema. The patient should be encouraged to maintain an adequate fluid intake. Warm sitz baths should be given three times daily. Kegel exercises are done to strengthen the pelvic muscles and therefore do not affect vesicovaginal fistula.
A patient who has severe abdominal pain is diagnosed with chronic pancreatitis secondary to cholecystitis. Which treatment option would the nurse anticipate will be planned?
Choledochojejunostomy Rationale When a patient with chronic pancreatitis is diagnosed with a biliary tract disease, surgery is required to treat the condition. The surgery involves diversion of bile flow and relieving the duct from obstruction. In patients with chronic pancreatitis, choledochojejunostomy is performed to divert bile flow around the ampulla of Vater. Therefore the nurse anticipates that choledochojejunostomy will be beneficial to the patient. Cholecystectomy is performed in patients with gallbladder disease. A Whipple procedure is the treatment option for patients with pancreatic cancer. Chemoembolization is performed in patients with liver cancer.
The nurse provides discharge education for a patient who underwent surgery for Crohn's disease. The nurse provides information about which early symptoms of bowel obstruction? Select all that apply.
Colicky abdominal pain Nausea and vomiting Abdominal distention Rationale The patient should be watchful for symptoms such as a colicky abdominal pain, nausea and vomiting, and abdominal distention. These are symptoms of bowel obstruction. Constipation and decreased flatus occur later.
Which medication is likely to cause flatulence in a patient who has gastroesophageal reflux disease (GERD)?
Dexlansoprazole Rationale Proton pump inhibitors such as dexlansoprazole are used to treat GERD and are associated with flatulence as a side effect. Sucralfate is an antiulcer agent that is associated with constipation. Famotidine is a histamine (H 2) receptor blocker that causes headaches, constipation, abdominal pain, and diarrhea as side effects. Abdominal pain, diarrhea, uterine rupture in pregnancy, and gastrointestinal bleeding are side effects associated with misoprostol.
The nurse is caring for a patient diagnosed with gastric outlet obstruction. Which assessment findings would support the diagnosis? Select all that apply.
Dilation of the stomach Swelling in the upper abdomen Rationale Over time, dilation of the stomach and visible swelling in the upper abdomen occur as a result of gastric outlet obstruction due to edema, inflammation, and fibrous scar tissue formation. A rigid board-like abdomen is indicative of perforated ulcer. Audible abdominal sounds are clinical manifestations of dumping syndrome. Continuous epigastric distress occurs after meals in patients with bile reflex gastritis.
A patient is prescribed an opioid agonist for treatment of irritable bowel syndrome with diarrhea (IBS-D). The drug decreases colonic contractions. The nurse educates the patient about which medication?
Eluxadoline Rationale Drug therapy for IBS focuses on the dominant bowel symptom and pain. The opioid agonist eluxadoline decreases colonic contractions to reduce diarrhea and pain. Other treatments for IBS-D include antispasmodic medications (e.g., hyoscyamine, dicyclomine). Antispasmodics decrease gastrointestinal (GI) motility and smooth muscle spasms, reducing pain and diarrhea. Loperamide is an antidiarrheal medication that slows the rhythm of digestion so that the small intestines have more time to absorb fluid and nutrients from the foods that are eaten.
The nurse reviews the medical record of a patient who is hospitalized with a suspected bowel obstruction. The nurse identifies that which factor in the patient's history places the patient at risk for colorectal cancer?
Familial adenomatous polyposis (FAP) Rationale Risk factors for colorectal cancer include a family or personal history of FAP. This tissue can degenerate over time and become malignant. Daily use of NSAIDs, GERD, and osteoarthritis do not place the patient at risk for colorectal cancer.
Which aspect would the nurse monitor for in a patient who has cholecystitis?
Gums for bleeding Rationale Cholecystitis is associated with decreased production of prothrombin, a clotting factor, thereby putting the patient at risk of bleeding. Common bleeding sites are mucous membranes of the gums, mouth, and nose, as well as injection sites. A patient with cholecystitis does not show alterations in blood glucose levels. Asterixis is a finding common in hepatic encephalopathy and would not be expected with cholecystitis. A patient with cholecystitis does not show alterations in serum creatinine levels.
Which are contraindications of enteral nutrition? Select all that apply.
Ileus Peritonitis Intestinal obstruction
A patient presents with frequent and copious vomiting and pain from intermittent cramping. While assessing the abdomen, the nurse auscultates high-pitched bowel sounds. The findings are consistent with which condition?
Intestinal obstruction
Which complications can occur due to long-term use of proton pump inhibitors in patients with gastroesophageal reflux disease (GERD)? Select all that apply.
Kidney disease Decreased bone density Magnesium deficiency Rationale Long-term use of PPIs may be associated with decreased bone density, kidney disease, vitamin B12 and magnesium deficiency, and increased risk for dementia. Renal calculi are associated with antacids. Prostaglandins can cause uterine rupture.
A patient with a three-day history of vomiting is suspected of having an obstruction in the upper duodenum. The nurse identifies that the patient is at risk for which condition?
Metabolic alkalosis
The nurse reviews the medical records of four patients and identifies that which patient is at highest risk for developing a duodenal ulcer?
Patient D: 40-yo male consumes 4c coffee a day smokes 1pk per day
A patient seeks treatment for a six-month history of frequent abdominal pain. The nurse recognizes that which conditions may be contributing to the patient's symptoms? Select all that apply.
Peptic ulcer disease Chronic pancreatitis Irritable bowel syndrome Rationale Peptic ulcer disease, chronic pancreatitis, and irritable bowel syndrome are common causes of chronic abdominal pain. Bowel obstruction and ruptured ectopic pregnancy are conditions that cause acute abdominal pain.
The nurse assesses a patient with irritable bowel syndrome (IBS). The nurse recalls that which nongastrointestinal symptom is associated with the diagnosis?
Sleep problems Rationale Nongastrointestinal (GI) symptoms of IBS may include fatigue, headache, and sleep problems. Restlessness, paresthesias (abnormal dermal sensation such as tingling, pricking, chilling, burning, or numb sensation on the skin with no apparent physical cause), and general muscle aches are not symptoms associated with IBS.
For which conditions is a person who is subjected to chronic stress at higher risk? Select all that apply.
The common cold Migraine headaches Irritable bowel syndrome
The nurse provides postoperative care for a patient one day after a hernia repair procedure. The patient's assessment findings include incisional pain, a temperature of 99.2°F (37.3°C), slight redness at the incision margins, and 20 mL of serosanguinous fluid in the surgical drain. How does the nurse interpret the data?
The patient is experiencing a normal inflammatory response.
Which is a cause of nonmechanical intestinal obstruction?
Thoracic spinal fracture Rationale Intestinal obstruction occurs when intestinal contents are unable to pass through the gastrointestinal tract. Paralytic ileus is the most common form of nonmechanical obstruction. A thoracic spinal fracture is a cause of paralytic ileus. Hernia, intussusceptions, and strictures from Crohn's disease cause mechanical obstruction.
Which food does the nurse suggest for a patient with abdominal cramps associated with irritable bowel syndrome (IBS)?
Yogurt Rationale A patient with IBS may have abdominal cramps with altered bowel patterns. Probiotics such as those in yogurt may be well tolerated, and they may alter intestinal bacteria balance to improve the condition. Fruits with peels may induce diarrhea and gastric discomfort from gas. Wheat contains fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) that may contribute to the IBS. Foods such as broccoli and cabbage may lead to abdominal distention and flatulence.
A patient is being admitted to the hospital with abdominal pain. Which information does the nurse include when obtaining the patient's gastrointestinal (GI) history? Select all that apply.
Hemorrhoids Lactose intolerance Abdominal distention Nausea and vomiting
Which symptom would patients with peptic ulcer disease (PUD) commonly report?
Epigastric discomfort relieved by eating Rationale Symptoms of PUD are variable and often absent. However, discomfort, if present, may occur before meals or two to three hours after meals and at bedtime. The discomfort may be relieved by eating because the food will dilute and buffer gastric acid. Although vomiting or abdominal distention after meals may occur and there may be an intolerance of fatty and spicy foods, they are less likely to be associated with PUD than is the relief caused by eating.
A patient reports nausea and burning epigastric pain. The patient takes nonsteroidal antiinflammatory drugs (NSAIDs) on a regular basis to relieve headaches. Which condition would the nurse suspect?
Gastritis
Which surgery is used to attach the stomach subdiaphragmatically and prevent reherniation?
Gastropexy Rationale: Gastropexy is the attachment of the stomach subdiaphragmatically to prevent reherniation. Herniotomy is the excision of the hernia sac. Herniorrhaphy is the closure of the hiatal defect. Heller myotomy is the surgical alteration of the lower esophageal sphincter.
A patient with periodontitis reports bleeding during toothbrushing and reveals a high intake of soft foods. Which infection would the nurse suspect?
Gingivitis Rationale: Bleeding during brushing and formations of abscess with loosening of teeth (periodontitis) are symptoms of gingivitis. It occurs in patients who eat soft foods instead of fibrous foods. Parotitis is the inflammation of the parotid gland in which there is pain in the parotid gland and ear. Inflammation of the mouth with excess salivation, sore mouth, and halitosis are symptoms of stomatitis. Oral candidiasis causes the formation of membranous lesions of mucosa of the mouth and larynx.
Which common cause of gastritis is also linked to development of stomach cancer?
Helicobacter pylori Rationale H. pylori is a common cause of gastritis. Prolonged inflammation due to H. pylori leads to functional changes in the stomach and may cause stomach cancer. Syphilis, cytomegalovirus, and Mycobacterium species also are causes of chronic gastritis, but they are not as common as H. pylori.
A patient is being admitted to the hospital with abdominal pain. Which information does the nurse include when obtaining the patient's gastrointestinal (GI) history? Select all that apply.
Hemorrhoids Lactose intolerance Abdominal distention Nausea and vomiting Rationale: The nurse should obtain information from the patient about the history or presence of the problems related to GI functioning and fully explore any symptoms. The nurse should ask the patient about a history or presence of diseases such as reflux, gastritis, hepatitis, colitis, gallstones, hemorrhoids, peptic ulcer, cancer, diverticula, or hernias. The nurse should document related conditions, such as food intolerance or allergies, lactose intolerance, and anemia. The nurse should ask about any abdominal pain, nausea, vomiting, abdominal distention, jaundice, heartburn, dyspepsia, changes in appetite, hematemesis, indigestion, bloating, and trouble swallowing. Nasal polyps are a condition related to the upper respiratory system. Monthly income is not directly relevant to the GI system in this context. Although economic status does influence diet and health from a broad public-health viewpoint, the health history is not about such topics; it is focused on specific conditions.
A patient experiences difficulty defecating due to constipation. A recommended treatment is the Valsalva maneuver. The nurse recognizes that it is important to obtain which history information prior to assisting the patient with this maneuver? Select all that apply.
Hemorrhoids Cardiac problems Abdominal Surgery Rationale The Valsalva maneuver involves contraction of the chest muscles on a closed glottis with simultaneous contraction of the abdominal muscles. The Valsalva maneuver may be contraindicated in the patient with a head injury, eye surgery, heart problems, hemorrhoids, abdominal surgery, or liver cirrhosis with portal hypertension. The Valsalva maneuver increases the abdominal pressure and may aggravate hemorrhoids. The increased abdominal pressure may also put undue pressure on the incision if the maneuver is performed after an abdominal surgery. The maneuver increases the workload of the heart and thus is not advised in patients with cardiac problems. A history of coughing and/or peptic ulcers is not relevant to performing the maneuver.
The nurse provides postoperative care for a patient who underwent an ostomy surgery, in which the stoma is located outside the rectus muscle site. The nurse monitors the patient for which postoperative complication?
Hernia Rationale: Placing a stoma outside the rectus muscle increases the chance of developing a hernia. Stomas should be placed on the flat site of the abdomen to avoid leakage. The nurse monitors blood flow to the stoma to prevent necrosis. Placement of the ostomy does not contribute to edema. The nurse should monitor coagulation factors to avoid moderate bleeding.
The nurse is caring for a patient with an acute onset of abdominal pain, nausea, and vomiting. A bowel obstruction is suspected. When auscultating the patient's abdomen, the nurse expects which bowel sounds?
High-pitched above the area of obstruction
The nurse observes that many elderly patients experience constipation related to which causes? Select all that apply.
Increased gastrointestinal transit time Decreased sensation to defecation Rationale: Increased gastrointestinal transit time and decreased sensation to defecation lead to constipation. Atrophy of gastric mucosa, decreased anal sphincter tone, and decreased blood flow to the stomach are also changes associated with aging. Atrophy of gastric mucosa causes anemia and food intolerance. Decreased anal sphincter tone can cause fecal incontinence. Decreased blood supply to the stomach also causes anemia and food intolerance.
Which interventions would the nurse expect for a patient who has anorexia, nausea, vomiting, epigastric pain, and a feeling of fullness? Select all that apply.
Inserting a nasogastric tube Administering IV fluids Maintaining the patient on NPO status Rationale Anorexia, nausea, vomiting, epigastric pain, and a feeling of fullness are the symptoms of acute gastritis. Therefore a nasogastric tube should be inserted to irrigate the precipitating agent from the stomach, to monitor bleeding, and to keep the stomach free from noxious smells. Administration of IV fluids may compensate for fluid loss in patients due to vomiting. The patient with acute gastritis should be kept on NPO status to prevent vomiting. Drug therapy for gastritis includes histamine (H 2) receptor blockers (ranitidine, cimetidine) and proton pump inhibitors (lansoprazole, omeprazole). The nurse should inform the patient about the therapeutic effects of the medications. Cimetidine is an H 2 receptor blocker that causes headache, abdominal pain, constipation, and diarrhea; it is not associated with fainting. Providing a nonirritating diet consisting of six small feedings per day is helpful for patients with chronic gastritis.
A patient reports a four-month history of infrequent bowel movements and a feeling of incomplete evacuation and is suspected to have irritable bowel syndrome. Which medication does the nurse anticipate discussing with the patient?
Linaclotide Rationale The patient is experiencing chronic constipation. Constipation is characterized by difficult or infrequent bowel movements, often accompanied by excessive exertion during defecation or a feeling of incomplete evacuation. Based on the stool patterns, the patient has IBS with constipation (IBS-C). Linaclotide is used to treat IBS-C. Alosetron is also used in the treatment of irritable bowel syndrome. However, this medication has the side effect of causing severe constipation. Loperamide is an antidiarrheal medication used in the treatment of diarrhea. Trimethobenzamide is an antiemetic medication used to prevent vomiting.
A patient who has been on a high dose of antibiotics for a year reports a sore mouth. The nurse finds bluish-white "milk-curd" lesions in the mouth. Which medication would the nurse expect to be prescribed?
Miconazole Rationale: Sore mouth and bluish-white "milk-curd" lesions on the mucosa of mouth indicate oral candidiasis caused by infection with yeast-like fungus. Oral candidiasis is caused by prolonged use of high-dose antibiotics. Miconazole is an antifungal medication used in the treatment of oral candidiasis. Acyclovir is used in the treatment of herpes simplex. Fluticasone and tetracycline are used in the treatment of aphthous stomatitis.
A patient with cholecystitis receives a prescription for cholestyramine in powdered form. Which medication instruction would the nurse provide?
Mix the medication with four to six ounces of milk. Rationale Cholestyramine is an antihistamine that effectively treats pruritus. The powdered form of cholestyramine should be mixed with four to six ounces of milk to ensure adequate absorption. Cholestyramine can be taken along with fruit juices and water. The powdered form of cholestyramine medication should be taken by mixing with milk or juice, not directly from the container.
The nurse assesses a patient and suspects appendicitis based on which findings? Select all that apply.
Muscle guarding Pain at McBurney's point Patient prefers to lie still, with the right leg flexed. Rationale Appendicitis typically begins with dull periumbilical pain, followed by anorexia, nausea, and vomiting. The pain is persistent and continuous, eventually shifting to the right lower quadrant and localizing at McBurney's point (halfway between the umbilicus and right iliac crest). A low-grade fever may develop. Further assessment reveals localized tenderness, rigidity, rebound tenderness, and muscle guarding. Coughing, sneezing, and deep inhalation worsen pain. The patient usually prefers to lie still, often with the right leg flexed. Fever may or may not be present; if present, then usually it is a low-grade fever. The pain increases during activities like coughing, sneezing, and deep breathing.
The nurse is caring for a patient undergoing chemotherapy for the treatment of cancer. Based on the history information, which assessment does the nurse complete first?
Oral Cavity Rationale: The patient underwent chemotherapy a week ago, and laboratory tests show that the electrolytes are at the lower end of the normal range with normal renal function. The patient presents with halitosis and weight loss. Therefore the nurse should assess the oral cavity for stomatitis or other infections. After assessing the oral cavity for lesions, the nurse can obtain the complete blood count, ask about the patient's last bowel movement, and then begin calculating intake and output.
An undernourished patient is admitted to the hospital with a gastrointestinal (GI) obstruction. Which does the nurse anticipate will be prescribed to meet nutritional needs?
Parenteral nutrition
Based on the assessment data collected on a patient with suspected cholecystitis, which action would the nurse take?
Prepare for nasogastric tube placement. Rationale The highest priority for this patient is the severe nausea and vomiting. Patients with severe nausea and vomiting secondary to cholecystitis require gastric decompression via a nasogastric tube. Placing the patient in a semi-Fowler's position may help if the patient is experiencing dyspnea but would not necessarily relieve the nausea and vomiting. Antiemetics are used for less severe nausea and vomiting. Food and fluid intake should be eliminated because they further stimulate the gallbladder.
A patient who has gastroesophageal reflux disease (GERD) is planning to become pregnant. Which type of medication would the nurse question being prescribed to treat the GERD?
Prostaglandins Rationale Prostaglandins are a class of medications that cause uterine rupture and miscarriage, so the nurse should question the use of prostaglandins for a patient with GERD who is intending to become pregnant. Cholinergics cause syncope, diarrhea, stomach cramps, and dizziness. Antiulcer agents such as sucralfate cause constipation. Headache, abdominal pain, constipation, and diarrhea are the side effects of H 2 receptor blockers.
The nurse is providing care to a patient with cholecystitis who is experiencing severe nausea and vomiting. Which intervention would the nurse plan to provide?
Providing oral care every two hours
The nurse provides discharge education for a patient with a diagnosis of chronic gastritis. Based on the diagnostic test results, which instruction does the nurse include in the teaching?
Receive cobalamin replacement therapy. Rationale: Due to chronic inflammatory changes to the gastric mucosa in patients with chronic gastritis, the stomach can no longer produce intrinsic factor, which is needed to absorb vitamin B 12. This is reflected by the decreased hemoglobin (Hgb), hematocrit (Hct), folate, and B 12 levels. Therefore the patient will develop pernicious anemia and requires lifelong cobalamin therapy. The patient should eliminate alcohol intake, not decrease drinking. Six smaller meals should be consumed per day to prevent gastric irritation. Acute gastritis and gastrointestinal bleeding would cause the nurse to assess for occult blood in the stool.
A patient who has acute cholecystitis is fearful of undergoing surgery and wants to try conservative management. Which prescriptions would the nurse expect to see entered in the patient record? Select all that apply.
Repeat complete blood count Hydromorphone 2 mg IV every six hours PRN for pain Ondansetron 4 mg IV every six hours for nausea and vomiting Rationale Conservative management for acute cholecystitis focuses on symptom management and observation for complications. A complete blood count monitors the white blood cell count; if elevated, this could signal infection. Patients with acute cholecystitis frequently have pain and may be treated with an IV opioid such as hydromorphone, and nausea and vomiting are other common symptoms that are frequently relieved with antiemetics. A regular diet is not indicated. These patients are initially required to fast and then progress to clear liquids. Insertion of a nasogastric tube may be indicated if the patient's condition worsens or if nausea and vomiting persist after the administration of antiemetics.
A patient's cholecystitis worsens overnight, and the patient is taken for a laparoscopic cholecystectomy. Upon returning to the medical-surgical unit, the patient reports shoulder pain, rated as an 8 out of 10 on the pain scale, and mild difficulty breathing. Which action would the nurse take first?
Reposition the patient on the left side with right knee flexed. Rationale Referred pain to the shoulder and dyspnea are common postoperative complaints after laparoscopic cholecystectomy because the carbon dioxide (CO 2) gas used to inflate the abdomen cannot be released or absorbed by the body. The CO 2 can irritate the phrenic nerve and diaphragm, causing some difficulty in breathing. Placing the patient in the Sims' position (on left side with right knee flexed) helps to move the gas pocket away from the diaphragm. The patient should be repositioned to move the gas pocket away from the phrenic nerve and the diaphragm to alleviate these symptoms, and the patient should be reassured that this event is expected. Analgesics can be administered to treat the pain. Referred shoulder pain can be one sign of an impending cardiac event; however, it is an expected complaint after this procedure and is likely not life-threatening. Supplemental oxygen is not indicated in this situation. This expected complaint should be documented in the patient's medical record, but the nurse likely does not need to alert the physician unless interventions fail to relieve the symptoms.
A patient is experiencing cheilosis. The nurse suspects that which is the cause of the patient's condition?
Riboflavin deficiency Rationale Riboflavin deficiency causes softening, fissuring, and cracking of the lips at the angles of the mouth; this results in cheilosis. Recessed gingivae and purulent pockets are symptoms of pyorrhea, which is a clinical manifestation of periodontitis in the patient. Leukoplakia are premalignant lesions that appear as thickened white patches in the mouth. Chronic constipation can result in hemorrhoids in the patient.
Which subjective description of pain would the nurse expect from a patient who has cholecystitis?
Right upper-quadrant pain radiating to the shoulder and scapula
A patient presents to the ambulatory clinic complaining of "stomach upset" that has occurred intermittently for the past several months. The patient does not want an invasive workup and would prefer to avoid medication therapy. Which goals would the nurse discuss with the patient and document in the care plan? Select all that apply.
Smoking cessation within the next 60 days Reducing calories to achieve a healthy weight Avoiding caffeinated and alcoholic beverages If the patient smokes, he or she should quit because nicotine is a trigger for many individuals with acid reflex because it lowers the lower esophageal sphincter (LES) pressure and put patients at risk for gastritis and peptic ulcer disease (PUD). Weight reduction in an overweight patient may help mitigate symptoms of many stomach disorders. Caffeine and alcohol both can trigger acid reflux by lowering LES pressure, as well as causing adverse effects in patients with PUD and gastritis. Exercise is an excellent recommendation for overall health and cardiovascular fitness, which may help with weight loss; however, it will not directly mitigate stomach symptoms. While the patient may need dietary changes, increasing consumption of acidic foods may aggravate symptoms; lifestyle management for many stomach disorders includes limiting foods with high acid content like orange juice and tomato-based foods.
