Honan-Chapter 23: Nursing Management: Patients With Gastric and Duodenal Disorders

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. Coffee-ground-like B. Clay-colored C. Black and tarry D. Bright red

C. Black and tarry RATIONALE Black, tarry stools are a sign of bleeding high in the GI tract, as from a gastric ulcer, and result from the action of digestive enzymes on the blood. Vomitus associated with upper GI tract bleeding commonly is described as coffee-ground-like. Clay-colored stools are associated with biliary obstruction. Bright red stools indicate lower GI tract bleeding.

The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding? A. Abdominal pain below the umbilicus B. Weight gain C. Bloating after meals D. Increased appetite

C. Bloating after meals RATIONALE Symptoms of progressive disease include bloating after meals, weight loss, abdominal pain above the umbilicus, loss or decrease in appetite, and nausea or vomiting.

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. "Be sure to wear sunscreen while taking this medicine." C. "Expect a metallic taste when taking this medicine, which is normal." D. "Do not drive when taking this medication."

"Be sure to wear sunscreen while taking this medicine." RATIONALE Tetracycline may cause a photosensitivity reaction in clients. The nurse should caution the client to use sunscreen when taking this drug. Dairy products can reduce the effectiveness of tetracycline, so the nurse should not advise him or her to take the medication with milk. A metallic taste accompanies administration of metronidazole (Flagyl). Administration of tetracycline does not necessitate driving restrictions.

Which medication should the nurse question before administering it to a patient with peptic ulcer disease? A. E-mycin, an antibiotic B. Prilosec, a PPI C. Flagyl, an antimicrobial agent D. Tylenol, a nonnarcotic analgesic

A. E-mycin, an antibiotic RATIONALE The antibiotic E-mycin is irritating to the GI tract and should be questioned in a patient with PUD.

Endoscopy of a 60-year-old woman has revealed the presence of an esophageal peptic ulcer. The nurse who is providing this woman's care is assessing for risk factors that may have contributed to the development of this disease. What question most directly addresses these risk factors? A. "Have you ever been diagnosed with reflux?" B. "Do you consider yourself to have a healthy diet?" C. "Have you been prone to infections over the past few years?" D. "Do you ever find it difficult to swallow certain foods?"

A. "Have you ever been diagnosed with reflux?" RATIONALE Gastroesophageal reflux disease (GERD) is a significant risk factor for peptic ulcer disease. Poor diet, general infections, and dysphagia are less closely associated with etiology of esophageal ulcers. Reference:

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 can be caused by ingestion of strong acids." B. "You may have ingested some irritating foods." C. "Is it possible that you are overusing aspirin." D. "It is a hereditary disease." E. "It is probably your nerves."

A. "It can be caused by ingestion of strong acids." B. "You may have ingested some irritating foods." C. "Is it possible that you are overusing aspirin." RATIONALE Acute gastritis is often caused by dietary indiscretion—the person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. Other causes of acute gastritis include overuse of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol intake, bile reflux, and radiation therapy. A more severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate.

Which of the following appears to be a significant factor in the development of gastric cancer? A. Diet B. Age C. Ethnicity D. Gender

A. Diet RATIONALE Diet seems to be a significant factor: a diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. The typical patient with gastric cancer is between 50 and 70 years of age. Men have a higher incidence than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop gastric cancer.

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. Hematemesis B. Bradycardia C. Hypertension D. Polyuria

A. Hematemesis RATIONALE The nurse interprets hematemesis as a sign/symptom of possible hemorrhage from the ulcer. Other signs that can indicate hemorrhage include tachycardia, hypotension, and oliguria/anuria.

Which medication classification represents a proton (gastric acid) pump inhibitor? A. Omeprazole B. Sucralfate C. Famotidine D. Metronidazole

A. Omeprazole RATIONALE Omeprazole decreases gastric acid by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells. Sucralfate is a cytoprotective drug. Famotidine is a histamine-2 receptor antagonist. Metronidazole is an antibiotic, specifically an amebicide.

A client reports diarrhea after having bariatric surgery. What nonpharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea? A. Decrease the fat content in the diet. B. Increase the fiber content in the diet. C. Decrease the amount of fluid the patient is drinking. D. Increase the protein content in the diet.

B. Increase the fiber content in the diet. RATIONALE Clients may complain of either diarrhea or constipation postprocedure. Diarrhea is more common an occurrence post bariatric surgery, particularly after malabsorptive procedures (Mechanick et al., 2008). Both may be prevented if the patient consumes a nutritious diet that is high in fiber. Steatorrhea also may occur as a result of rapid gastric emptying, which prevents adequate mixing with pancreatic and biliary secretions. In mild cases, reducing the intake of fat and administering an antimotility medication (e.g., loperamide [Imodium]) may control symptoms.

A client who is being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for obstruction which would be indicated by what amount? A. 150 mL B. 250 mL C. 350 mL D. 450 mL

D. 450 mL RATIONALE A residual of greater than 400 mL strongly suggests obstruction.

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 intial appropriate action by the nurse? A. Notify the health care provider. B. Irrigate the client's NG tube. C. Place the client in the high- Fowler's position. D. Assess the client's abdomen and vital signs.

D. Assess the client's abdomen and vital signs. RATIONALE Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

Which of the following clients is at highest risk for peptic ulcer disease? A. Client with blood type A B. Client with blood type B C. Client with blood type AB D. Client with blood type O

D. Client with blood type O RATIONALE Clients with blood type O are more susceptible to peptic ulcers than those with blood types A, B, and AB.

A patient presents to the walk-in clinic complaining of vomiting and burning in his mid-epigastria. The nurse knows that to confirm peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what? A. Infection with Helicobacter pylori B. Excessive stomach acid secretion C. Gastric irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs) D. Inadequate production of pancreatic enzymes

A. Infection with Helicobacter pylori RATIONALE H. pylori infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen. Other less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test. Excessive stomach acid secretion, NSAIDs, and dietary indiscretion may all cause gastritis; however, peptic ulcers are caused by colonization of the stomach by H. pylori. Reference:

A 32-year-old man who has a body mass index of 32 (morbidly obese) is considering bariatric surgery. In the time leading up to this surgery, which of the following nursing diagnoses will be the primary focus of interventions? A. Knowledge deficit related to the implications of bariatric surgery B. Altered growth and development related to obesity C. Risk for injury related to obesity D. Spiritual distress related to low body image

A. Knowledge deficit related to the implications of bariatric surgery RATIONALE Patient teaching is a priority in the preparation for bariatric surgery. Necessary counseling and education would be prioritized over growth and development and spiritual distress, although each may emerge and be addressed accordingly. In seeking bariatric surgery, the patient is likely already aware of the risks associated with obesity.

A nurse assesses the stools of a client diagnosed with peptic ulcer disease. Inspection reveals black, tarry stools. The nurse would use which term to document this finding? A. melana B. hematemesis C. pyrosis D. achlorhydria

A. melana RATIONALE Melena is the term used to denote black, tarry stools. Hematemesis refers to blood in vomit. Pyrosis is a burning sensation in the esophagus and stomach that moves up to the mouth. Achlorhydria refers to an absence of hydrochloric acid in the stomach. Reference:

The nurse is planning for the discharge of a client with peptic ulcer disease. Which outcome must be included in the plan of care? A. The client's pain is controlled with NSAIDs. B. The client understands and maintains lifestyle modifications. C. The client takes antacids around the clock. D. The client has no episodes of GI bleeding.

B. The client understands and maintains lifestyle modifications. RATIONALE Maintaining the lifestyle adjustments of eating an appropriate diet, reducing stress, decreasing or stopping smoking, and following a medication regimen are the goal to treat and prevent complications.

What assessment finding supports a client's diagnosis of gastric ulcer? A. Presence of blood in the client's stool for the past month B. Complaints of sharp pain in the abdomen after eating a heavy meal C. Periods of pain shortly after eating any food. D. Complaints of epigastric burning that moves like a wave

C. Periods of pain shortly after eating any food. RATIONALE Experiencing sharp pain 30 to 60 minutes after meals is common with gastric ulcers; patients with duodenal ulcers can have night pain that is relieved by eating.

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 intial appropriate action by the nurse? A. Notify the health care provider. B. Irrigate the client's NG tube. C. Place the client in the high-Fowler's position. D. Assess the client's abdomen and vital signs.

D. Assess the client's abdomen and vital signs. RATIONALE Signs and symptoms of perforation includes sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm. The nurse should assess the vital signs and abdomen prior to notifying the physician. Irrigation of the NG tube should not be performed because the additional fluid may be spilled into the peritoneal cavity, and the client should be placed in a position of comfort, usually on the side with the head slightly elevated.

The client with a peptic ulcer is admitted to the hospital's intensive care unit with obvious gastric bleeding. What is the priority intervention for the nurse? A. Keep an accurate record of intake and output. B. Provide for quiet environment, restrict visitors. C. Prepare the client for an endoscopy. D. Monitor vital signs and observe for signs of hypovolemia.

D. Monitor vital signs and observe for signs of hypovolemia. RATIONALE The goal is to directly stop the bleeding and remove blood/clots/secretions from GI tract so that an endoscopy can be performed and the patient does not vomit and aspirate gastric contents.

Which of the following is the most successful treatment for gastric cancer? A. Removal of the tumor B. Chemotherapy C. Radiation D. Palliation

A. Removal of the tumor RATIONALE There is no successful treatment for gastric carcinoma except removal of the tumor. If the tumor can be removed while it is still localized to the stomach, the patient may be cured. If the tumor has spread beyond the area that can be excised, cure is less likely.

The nurse is providing care to a client who has had a percutaneous liver biopsy. The nurse would monitor the client for which of the following? A. Signs and symptoms of bleeding B. Return of the gag reflex C. Passage of stool D. Intake and output

A. Signs and symptoms of bleeding RATIONALE A major complication after a liver biopsy is bleeding, so it would be important for the nurse to monitor the client for signs and symptoms of bleeding. Return of the gag reflex would be important for the client who had an esophagogastroduodenoscopy to prevent aspiration. Monitoring the passage of stool would be important for a client who had a barium enema or colonoscopy. Monitoring intake and output is a general measure indicated for any client. It is not specific to a liver biopsy.

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. Peritonitis D. A normal reaction to surgery

A. Vasomotor symptoms associated with dumping syndrome RATIONALE Early manifestations of dumping syndrome occur 15 to 30 minutes after eating. Signs and symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, diarrhea, nausea, and the desire to lie down. Dehiscence of the surgical wound is characterized by pain and a pulling or popping feeling at the surgical site. Peritonitis presents with a rigid, boardlike abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery. Reference:

A 47-year-old man with epigastric pain is being admitted to the hospital. During the admission assessment and interview, what specific information should the nurse obtain from the patient, who is suspected of having peptic ulcer disease? A. Any allergies to food or medications B. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) C. Medical history for two previous generations D. History of side effects of all medications

B. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) RATIONALE Use of NSAIDs in the patient suspected of peptic ulcer disease increases the risk of GI bleeding.

An obese male patient has sought advice from the nurse about the possible efficacy of medications in his efforts to lose weight. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity? A. "Medications are usually reserved for people who have had unsuccessful bariatric surgery." B. "Medications may be of some use, but they don't tend to resolve obesity on their own." C. "Medications are an excellent option for individuals who prefer not to exercise or reduce their food intake." D. "Medications have the potential to reduce hunger but they rarely result in weight loss."

B. "Medications may be of some use, but they don't tend to resolve obesity on their own." RATIONALE Medications for obesity rarely result in loss of more than 10% of total body weight. They are not intended as a substitute for exercise or a healthy diet. They are not solely intended for those individuals who have undergone bariatric surgery.

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. Gastric outlet obstruction B. Dumping syndrome C. Bile reflux D. Celiac disease

B. Dumping syndrome RATIONALE Dumping syndrome is an unpleasant set of vasomotor and GI symptoms that occur in up to 76% of patients who have had bariatric surgery. Early symptoms include a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. These symptoms resolve once the intestine has been evacuated (i.e., with defecation).

A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that, in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what? A. Knowledge of the causes of obesity and its associated risks B. Emotional stability and understanding of required lifestyle changes. C. Positive body image and high self-esteem D. Insight into why their past weight loss efforts failed

B. Emotional stability and understanding of required lifestyle changes. RATIONALE Patients seeking bariatric surgery must be evaluated by a psychiatrist, psychologist, or advanced practice mental health nurse to establish that they are free of serious mental disorders and are motivated to comply with lifestyle changes related to eating patterns, dietary choices, and elimination. Obese patients are often unlikely to have a positive body image due to the social stigma associated with obesity. While assessment of knowledge about causes of obesity and its associated risks, as well as insight into the reasons why previous diets have been ineffective are included in the patient's plan of care, these do not predict positive patient outcomes following bariatric surgery. Most obese patients have an impaired body image and alteration in self-esteem. An obese patient with a positive body image would be unlikely to seek this surgery unless she or he was experiencing significant comorbidities.

The nurse is performing detailed patient education with a 40-year-old woman who will be soon discharged following a Roux-en-Y gastric bypass. The nurse and other members of the interdisciplinary team have been emphasizing the need for eating small amounts of food at a sitting and eating food slowly. What is the rationale for the nurse's advice? A. Eating too quickly can cause gastric ulceration. B. The cardiac sphincter is unable to dilate quickly after bariatric surgery. C. Nausea and esophageal distention can result from eating too fast. D. Eating quickly is associated with weight gain.

C. Nausea and esophageal distention can result from eating too fast. RATIONALE Because of the physical alterations to the upper gastrointestinal (GI) tract that are created during bariatric surgery, the patient is prone to nausea and esophageal distention if he or she eats too quickly. Eating quickly does not contribute to ulceration or weight gain following surgery. The cardiac sphincter is not modified during bariatric surgery.

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. Ineffective treatment for the peptic ulcer B. A reaction to the medication given for the ulcer C. Gastric penetration D. Perforation of the peptic ulcer

D. Perforation of the peptic ulcer RATIONALE Signs and symptoms of perforation include the following: Sudden, severe upper abdominal pain (persisting and increasing in intensity), which may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (boardlike) abdomen; and hypotension and tachycardia, indicating shock.

A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? A. Three meals and 120 ml fluid daily B. Three meals and three snacks and 120 mL fluid daily C. Six small meals and 120 mL fluid daily D. Six small meals daily with 120 mL fluid between meals

D. Six small meals daily with 120 mL fluid between meals RATIONALE After the return of bowel sounds and removal of the nasogastric tube, the nurse may give fluids, followed by food in small portions. Foods are gradually added until the client can eat six small meals a day and drink 120 mL of fluid between meals. Reference:

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: A. restrict fluid intake to 1 qt (1,000 ml)/day. B. drink liquids only with meals. C. don't drink liquids 2 hours before meals. D. drink liquids only between meals.

D. drink liquids only between meals. RATIONALE A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.