Management of Patients With Gastric and Duodenal Disorders EXAM 1 PREP U NU102
A client is suspected of having a slow gastrointestinal bleed. The nurse should evaluate the client for which sign? 1. tarry stools 2. increased pulse 3. nausea 4. abdominal cramps
Correct response: tarry stools Explanation: Black, tarry stools indicate the presence of a slow upper gastrointestinal bleed. The longer the blood is in the system, the darker it becomes as the hemoglobin is broken down and iron is released. Vital sign changes, such as an increased pulse, are not evident with slow gastrointestinal bleeds. Nausea and abdominal cramps can occur but are not definitive signs of gastrointestinal bleeding.
Which is a true statement regarding the nursing considerations in administration of metronidazole? 1. It may cause weight gain. 2. The drug should be given before meals. 3. Metronidazole decreases the effect of warfarin. 4. It leaves a metallic taste in the mouth.
Correct response: It leaves a metallic taste in the mouth. Explanation: Metronidazole leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease gastrointestinal upset. Metronidazole increases the blood-thinning effects of warfarin.
A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. 1. Liver 2. Lungs 3. Duodenum 4. Bladder 5. Pancreas
Correct response: Liver Pancreas Duodenum Explanation: Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.
The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol? 1. Decreases mucus production 2. Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) 3. Works best when taken on an empty stomach I4. ncreases the speed of gastric emptying
Correct response: Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Misoprostol (Cytotec) is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.
While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which interventions? Choose all that apply. 1. Inform the client that he will receive a sedative before the procedure. 2. Administer a preparation to cleanse the GI tract, such as Golytely or Fleets Phospha-Soda. 3. Tell the client that he may eat and drink immediately after the procedure. 4. Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure. Tell the client he must be on a clear liquid diet for 24 hours before the procedure.
Correct response: Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure. Inform the client that he will receive a sedative before the procedure. Explanation: The client should be NPO for 8 hours prior to the examination. Before the introduction of the endoscope, the client is given a local anesthetic gargle or spray. Midazolam (Versed), a sedative that provides moderate sedation and relieves anxiety during the procedure, may be administered. Atropine may be administered to reduce secretions, and glucagon may be administered to relax smooth muscle.
A healthcare provider prescribes a combination of drugs to treat reoccurring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client? 1. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. 2. The proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori. 3. The antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori. 4. The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori.
Correct response: The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. Explanation: The recommended combination of bismuth salts, antibiotics, and proton pump inhibitors will suppress or eradicate H. pylori. Prostaglandin E1 analogs enhance mucosal resistance to injury; they do not suppress or eradicate H. pylori.
The nurse is providing instructions to a client scheduled for a gastroscopy. What should the nurse be sure to include in the instructions? Select all that apply. The client must have bowel cleansing prior to the procedure. The throat will be sprayed with a local anesthetic. After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours). The client must fast for 8 hours before the examination. The health care provider will be able to determine if there is a presence of bowel disease.
Correct response: The client must fast for 8 hours before the examination. The throat will be sprayed with a local anesthetic. After gastroscopy, the client cannot eat or drink until the gag reflex returns (1 to 2 hours). Explanation: The client should be NPO for 8 hours prior to the examination. Before the introduction of the endoscope, the client is given a local anesthetic gargle or spray. Midazolam (Versed), a sedative that provides moderate sedation with loss of the gag reflex and relieves anxiety during the procedure, is administered. Temporary loss of the gag reflex is expected; after the client's gag reflex has returned, lozenges, saline gargle, and oral analgesic agents may be offered to relieve minor throat discomfort.
A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: 1. a sedentary lifestyle and smoking. 2. alcohol abuse and smoking. 3. alcohol abuse and a history of acute renal failure. 4. a history of hemorrhoids and smoking.
Correct response: alcohol abuse and smoking. Explanation: The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
Which medication classification represents a proton (gastric acid) pump inhibitor? 1. Omeprazole 2. Metronidazole 3. Sucralfate 4. Famotidine
Correct response: Omeprazole Explanation: 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 nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? 1. "I will call my physician if I begin to have abdominal pain." 2. "I will have to take vitamin B12 shots up to 1 year after surgery." 3. "I'm going to visit my pastor weekly for a while." 4. "I will weight myself each day and record the weight."
Correct response: "I will have to take vitamin B12 shots up to 1 year after surgery." Explanation: After a total gastrectomy, a client will need to take vitamin B12 shots for life. Dietary B12 is absorbed in the stomach, and the inability to absorb it could lead to pernicious anemia. Visiting clergy for emotional support is normal after receiving a cancer diagnosis. This action should be encouraged by the nurse. It's appropriate for the client to call the physician if he experiences signs and symptoms of intestinal blockage or obstruction, such as abdominal pain. Because a client with a total gastrectomy will receive enteral feedings or parenteral feedings, he should weigh himself each day and keep a record of the weights.
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.) 1. "It can be caused by ingestion of strong acids." 2. "It is probably your nerves." 3. "It is a hereditary disease." 4. "You may have ingested some irritating foods." 5. "Is it possible that you are overusing aspirin."
Correct response: "It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." Explanation: 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.
A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen? 1. "The medications will kill the bacteria and stop the acid production." 2. "I should take these medications only when I have pain from my ulcer." 3. "These medications will coat the ulcer and decrease the acid production in my stomach." 4. "My ulcer will heal because these medications will kill the bacteria."
Correct response: "The medications will kill the bacteria and stop the acid production." Explanation: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton-pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton-pump inhibitor and bismuth salts (Pepto-Bismol). Research is being conducted to develop a vaccine against H. pylori.
The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction between gastric and duodenal ulcers. 1. Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) 2. Amount of hydrochloric acid (HCL) secretion in the stomach 3. Patient's age 4. Presence of H. pylori
Correct response: Amount of hydrochloric acid (HCL) secretion in the stomach Explanation: A duodenal ulcer is characterized by hypersecretion of stomach acid, whereas a gastric ulcer shows evidence of hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.
The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? 1. Hemorrhage 2. Awakening in pain 3. Constipation 4. Vomiting
Correct response: Awakening in pain Explanation: The client with a duodenal ulcer is more likely to awaken with pain during the night than is the client with a gastric ulcer. Vomiting, constipation, diarrhea, and bleeding are symptoms common to both gastric and duodenal ulcers.
The nurse is providing preoperative care for a client with gastric cancer who is having a resection. What is the nursing management priority for this client? 1. Discharge planning 2. Preventing deep vein thrombosis (DVT) 3. Correcting nutritional deficits 4. Teaching about radiation treatment
Correct response: Correcting nutritional deficits Explanation: Clients with gastric cancer commonly have nutritional deficits and may have cachexia. Therefore, correcting nutritional deficits is a top priority. Discharge planning before surgery is important, but correcting the nutritional deficits is a higher priority. Radiation therapy hasn't been proven effective for gastric cancer, and teaching about it preoperatively wouldn't be appropriate. Preventing DVT isn't a high priority before surgery, but it assumes greater importance after surgery.
The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following? 1. Pylorus 2. Duodenum 3. Stomach 4. Esophagus
Correct response: Duodenum Explanation: Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.
The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following? 1. Esophagus 2. Duodenum 3. Pylorus 4. Stomach
Correct response: Duodenum Explanation: Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.
A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems? 1. Gastric ulcer 2. Gastric cancer 3. Acute gastritis 4. Duodenal ulcer
Correct response: Acute gastritis Explanation: A client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccupping, which can last from a few hours to a few days. Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. A client with a duodenal ulcer will present with heartburn, nausea, excessive gas and vomiting. A client with gastric cancer will have persistent symptoms of nausea and vomiting, not sudden symptoms. A client with a gastric ulcer will have bloating, nausea, and vomiting, but not necessarily hiccups.
A client who had abdominal surgery 4 days ago reports that "something gave way" during a sneeze. The nurse observes a wound evisceration. What should the nurse do next? 1. Notify the health care provider. 2. Measure the length of the protrusion. 3. Assess heart rate and blood pressure. 4. Apply a sterile, moist dressing.
Correct response: Apply a sterile, moist dressing. Explanation: Evisceration involves separation of all layers of the abdominal wall, resulting in protrusion of abdominal contents. The nurse's first priority should be to protect the client's abdominal contents. She should apply warm, sterile saline dressings over the protruding viscera. Next, the nurse should institute NPO status because the client will ultimately need surgery. The client is at risk for shock, so the nurse should monitor vital signs frequently after applying the sterile, moist dressing. The extensiveness of the protrusion is not important, it will need surgical repair regardless.
Which of the following clients is at highest risk for peptic ulcer disease? 1. Client with blood type AB 2. Client with blood type A 3. Client with blood type B 4. Client with blood type O
Correct response: Client with blood type O Explanation: Clients with blood type O are more susceptible to peptic ulcers than those with blood types A, B, and AB.
A nurse is caring for a client who is postoperative day 3 after an appendectomy. The client is not eating well and reports feeling bloated and slightly queasy. What should be the nurse's priority action? 1. Request prescriptions for antiemetic and laxatives. 2. Encourage client to ambulate and increase fluids. 3. Complete a thorough gastrointestinal focused assessment. 4. Reassure the client that this is common after abdominal sugary.
Correct response: Complete a thorough gastrointestinal focused assessment. Explanation: Postoperative constipation is common. Pain can reduce the client's ability to strain, and opioid analgesics such as morphine slow peristalsis, causing constipation. The nurse should focus first on an abdominal assessment, including determining when the client's last bowel movement and quality of bowel sounds. The nurse only requests prescriptions or encourages nonpharmacological interventions for constipation after assessment is complete and does not dismiss the client's reports as normal.
Which ulcer is associated with extensive burn injury? 1. Cushing ulcer 2. Curling ulcer 3. Peptic ulcer 4. Duodenal ulcer
Correct response: Curling ulcer Explanation: Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.
A client with inflammatory bowel disease undergoes an ileostomy. On the first day after surgery, the nurse notes that the client's stoma appears dusky. How should the nurse interpret this finding? 1. This is a normal finding 1 day after surgery. 2. Blood supply to the stoma has been interrupted. 3. An intestinal obstruction has occurred. 4. The ostomy bag should be adjusted.
Blood supply to the stoma has been interrupted. Correct response: Blood supply to the stoma has been interrupted. Explanation: An ileostomy stoma forms as the ileum is brought through the abdominal wall to the surface skin, creating an artificial opening for waste elimination. The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests decreased perfusion. The nurse should interpret this finding as an indication that the stoma's blood supply is interrupted, which may lead to tissue damage or necrosis. A dusky stoma isn't a normal finding 1 day after surgery. Adjusting the ostomy bag wouldn't affect stoma color, which depends on blood supply to the area. An intestinal obstruction also wouldn't change stoma color.
Which medication is classified as a histamine-2 receptor antagonist? 1. Metronidazole 2. Esomeprazole 3. Lansoprazole 4. Famotidine
Correct response: Famotidine Explanation: Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.
The nurse advises the patient who has just been diagnosed with acute gastritis to: 1. Restrict food and fluids for 12 hours. 2. Refrain from food until the GI symptoms subside. 3. Take an emetic to rid the stomach of the irritating products. 4. Restrict all food for 72 hours to rest the stomach.
Correct response: Refrain from food until the GI symptoms subside. Explanation: It usually takes 24 to 48 hours for the stomach to recover from an attack. Refraining from food until symptoms subside is recommended, but liquids should be taken in moderation. Emetics and vomiting can cause damage to the esophagus.
A client is admitted with acute pancreatitis. The nurse should monitor which laboratory values? 1. increased calcium level 2. decreased glucose level 3. decreased urine amylase level 4. increased serum amylase and lipase levels
Correct response: increased serum amylase and lipase levels Explanation: Serum amylase and lipase are increased in pancreatitis, as is urine amylase. Other abnormal laboratory values include decreased calcium level and increased glucose and lipid levels.
A nurse is providing education to a client with GERD. The client asks what measures can be taken independently to help reduce the symptoms. Which interventions would the nurse recommend? Select all that apply. 1. maintaining an upright position following meals 2. sleeping in a supine position 3. ensuring intake of food and fluids 2 to 3 hours before bedtime 4. avoiding foods that intensify symptoms
Correct response: maintaining an upright position following meals avoiding foods that intensify symptoms Explanation: Conservative measures used in the treatment of GERD are maintaining an upright position following meals, avoiding foods that intensify symptoms, elevating the head of the bed when sleeping, and avoiding the intake of food and fluids 2 to 3 hours before bedtime.
A client with end-stage pancreatic cancer has decided to terminate medical intervention. What should a nurse anticipate when consulting with palliative care? 1. decreased need for nutritional supplementation 2. decreased need for antidepressant medication 3. referral for bereavement counseling 4. decreased need for pain medications
Correct response: referral for bereavement counseling Explanation: Referral to a bereavement counselor may help the client and the client's family make decisions about unfinished business. This client should continue to receive pain medications, antidepressants, and nutritional therapy at home and in the hospice setting. It isn't appropriate to decrease these comfort measures.
The nurse is admitting a client whose medication regimen includes regular injections of vitamin B12. The nurse should question the client about a history of: 1. gastroesophageal reflux disease (GERD). 2. total gastrectomy. 3. diverticulitis. 4. bariatric surgery.
Correct response: total gastrectomy. Explanation: If a total gastrectomy is performed, injection of vitamin B12 will be required for life, because intrinsic factor, secreted by parietal cells in the stomach, binds to vitamin B12 so that it may be absorbed in the ileum. Bariatric surgery, diverticulitis and GERD do not necessitate total gastrectomy and subsequent vitamin B12 supplementation.
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? 1. Three meals and three snacks and 120 mL fluid daily 2. Six small meals daily with 120 mL fluid between meals 3. Three meals and 120 ml fluid daily 4. Six small meals and 120 mL fluid daily
Correct response: Six small meals daily with 120 mL fluid between meals Explanation: 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.
To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instruction? 1. "Lie down after meals to promote digestion." 2. "Take antacids with meals." 3. "Avoid coffee and alcoholic beverages." 4. "Limit fluid intake with meals."
Correct response: "Avoid coffee and alcoholic beverages." Explanation: To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client need not limit fluid intake with meals as long as the fluids aren't gastric irritants.
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience 1. pain 2 to 3 hours after a meal. 2. hemorrhage. 3. vomiting. 4. weight loss.
Correct response: pain 2 to 3 hours after a meal. Explanation: The client with a gastric ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.
A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? 1. 4 to 6 days 2. 10 to 14 days 3. 15 to 20 days 4. 7 to 9 days
Correct response: 10 to 14 days Explanation: Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts (Pepto-Bismol).
The nurse is assessing a client with advanced gastric cancer. The nurse anticipates that the assessment will reveal which finding? 1. Increased appetite 2. Abdominal pain below the umbilicus 3. Bloating after meals 4. Weight gain
Correct response: Bloating after meals Explanation: 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 nurse is teaching a client with gastritis about the need to avoid the intake of caffeinated beverages. The client asks why this is so important. Which explanation from the nurse would be most accurate? 1. "Caffeine increases the fluid volume in your system, which irritates your digestive organs." 2. "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems." 3. "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." 4. "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage."
Correct response: "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." Explanation: Caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. Caffeine is a diuretic that causes decreased fluid volume and potential dehydration. It does not lead to hemorrhage and does not interfere with absorption of vitamin B12.
The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client makes which statement? 1. "I should stop all my medications if I develop any side effects." 2. "I should continue my treatment regimen as long as I have pain." 3. "I can buy whatever antacids are on sale because they all have the same effect." 4. "I have learned some relaxation strategies that decrease my stress."
Correct response: "I have learned some relaxation strategies that decrease my stress." Explanation: The nurse assists the client to identify stressful or exhausting situations. A hectic lifestyle and an irregular schedule may aggravate symptoms and interfere with regular meals taken in relaxed settings along with the regular administration of medications. The client may benefit from regular rest periods during the day, at least during the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may be helpful.
A nurse is providing preprocedure education for a client who will undergo a lower GI tract study the following week. What should the nurse teach the client about bowel preparation? 1. "For 24 hours before the test, insert a glycerin suppository every 4 hours." 2. "You'll need to have enemas the day before the test." 3. "You'll need to fast for at least 18 hours prior to your test." 4. "Starting today, take over-the-counter (OTC) stool softeners twice daily."
Correct response: "You'll need to have enemas the day before the test." Explanation: Preparation of the client includes emptying and cleansing the lower bowel. This often necessitates a low-residue diet 1 to 2 days before the test; a clear liquid diet and a laxative the evening before; NPO after midnight; and cleansing enemas until returns are clear the following morning.
A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? 1. 4 to 6 days 2. 15 to 20 days 3. 10 to 14 days 4. 7 to 9 days
Correct response: 10 to 14 days Explanation: Recommended therapy for 10 to 14 days includes triple therapy with two antibiotics (e.g., metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton pump inhibitor (e.g., lansoprazole [Prevacid], omeprazole [Prilosec], or rabeprazole [Aciphex]), or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts (Pepto-Bismol).
A nurse is providing care for a client who is postoperative day 2 following gastric surgery. The nurse's assessment should be planned in light of the possibility of what potential complications? Select all that apply. 1. Pneumonia 2. Chronic gastritis 3. Malignant hyperthermia 4. Hemorrhage 5. Atelectasis
Correct response: Atelectasis Pneumonia Hemorrhage Explanation: After surgery, the nurse assesses the client for complications secondary to the surgical intervention, such as pneumonia, atelectasis, or metabolic imbalances resulting from the GI disruption. Malignant hyperthermia is an intraoperative complication. Chronic gastritis is not a surgical complication.
A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history: 1. Diabetes 2. Peptic ulcer disease 3. Coronary artery disease 4. Use of lithium
Correct response: Coronary artery disease Explanation: Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.
A client has been hospitalized with pancreatitis for 3 days. The nurse assesses the client and documents the accompanying results. The nurse realizes these findings are a manifestation of what sign? 1. Broca's sign 2. Cullen's sign 3. Trousseau's sign 4. Chvostek's sign
Correct response: Cullen's sign Explanation: Cullen's sign is evidenced by discoloration at the periumbilical area. This sign may indicate an underlying subcutaneous intraperitoneal hemorrhage. Chvostek's sign is a facial nerve spasm and Trousseau's sign is a carpopedal spasm; both signs occur with hypocalcemia. Broca's area, not sign, is an area within the brain that controls the motor functions involved in speech.
A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? 1. Peptic ulcer 2. Esophageal ulcer 3. Meckel's ulcer 4. Curling's ulcer
Correct response: Curling's ulcer Explanation: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.
A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? 1. Peptic ulcer 2. Esophageal ulcer 3. Meckel's ulcer 4. Curling's ulcer
Correct response: Curling's ulcer Explanation: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.
Clients with Type O blood are at higher risk for which of the following GI disorders? 1. Gastric cancer 2. Esophageal varices 3. Diverticulitis 4. Duodenal ulcers
Correct response: Duodenal ulcers Explanation: Familial tendency also may be a significant predisposing factor. People with blood type O are more susceptible to peptic ulcers than are those with blood type A, B, or AB. Blood type is not a predisposing factor for gastric cancer, esophageal varices, and diverticulitis.
The nurse is developing a plan of care for a patient with peptic ulcer disease. What nursing interventions should be included in the care plan? Select all that apply. 1. Checking the blood pressure and pulse rate every 15 to 20 minutes 2. Observing stools and vomitus for color, consistency, and volume 3. Making neurovascular checks every 4 hours 4. Frequently monitoring hemoglobin and hematocrit levels 5. Inserting an indwelling catheter for incontinence
Correct response: Frequently monitoring hemoglobin and hematocrit levels Observing stools and vomitus for color, consistency, and volume Checking the blood pressure and pulse rate every 15 to 20 minutes Explanation: The nurse assesses the patient for faintness or dizziness and nausea, which may precede or accompany bleeding. The nurse must monitor vital signs frequently and evaluate the patient for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production).
The nurse is cautiously assessing a client admitted with peptic ulcer disease because the most common complication that occurs in 10% to 20% of clients is: 1. Hemorrhage 2. Perforation 3. Pyloric obstruction 4. Intractable ulcer
Correct response: Hemorrhage Explanation: Hemorrhage, the most common complication, occurs in 10% to 20% of clients with peptic ulcers. Bleeding may be manifested by hematemesis or melena. Perforation is erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Intractable ulcer refers to one that is hard to treat, relieve, or cure. Pyloric obstruction, also called gastric outlet obstruction (GOO), occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down
Which of the following is the most common complication associated with peptic ulcer? 1. Vomiting 2. Hemorrhage 3. Abdominal pain 4. Elevated temperature
Correct response: Hemorrhage Explanation: Hemorrhage, the most common complication, occurs in 28% to 59% of patients with peptic ulcers. Vomiting, elevated temperature, and abdominal pain are not the most common complications of a peptic ulcer.
Which of the following is the most common complication associated with peptic ulcer? 1. Abdominal pain 2. Vomiting 3. Hemorrhage 4. Elevated temperature
Correct response: Hemorrhage Explanation: Hemorrhage, the most common complication, occurs in 28% to 59% of patients with peptic ulcers. Vomiting, elevated temperature, and abdominal pain are not the most common complications of a peptic ulcer.
A client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has stopped draining. How should the nurse respond? 1. Increase the suction level. 2. Notify the physician. 3. Reposition the tube. 4. Irrigate the tube.
Correct response: Notify the physician. Explanation: The nurse should notify the physician because an NG tube that fails to drain during the postoperative period may be clogged, which could increase pressure on the suture site because fluid isn't draining adequately. Repositioning or irrigating an NG tube in a client who has undergone gastric surgery can disrupt the anastomosis. Increasing the level of suction may cause trauma to GI mucosa or the suture line.
Peptic ulcer disease occurs more frequently in people with which blood type? 1. O 2. B 3. AB 4. A
Correct response: O Explanation: People with blood type O are more susceptible to peptic ulcers than those with blood type A, B, or AB.
The nurse advises the patient who has just been diagnosed with acute gastritis to: 1. Take an emetic to rid the stomach of the irritating products. 2. Restrict food and fluids for 12 hours. 3. Refrain from food until the GI symptoms subside. 4. Restrict all food for 72 hours to rest the stomach.
Correct response: Refrain from food until the GI symptoms subside. Explanation: It usually takes 24 to 48 hours for the stomach to recover from an attack. Refraining from food until symptoms subside is recommended, but liquids should be taken in moderation. Emetics and vomiting can cause damage to the esophagus.
Which of the following is the most successful treatment for gastric cancer? 1. Removal of the tumor 2. Palliation 3. Chemotherapy 4. Radiation
Correct response: Removal of the tumor Explanation: 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.
Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. 1. Hypocalcemia 2. Extreme gastric hyperacidity 3. Severe peptic ulcers 4. Gastrin-secreting tumors of the pancreas 5. Constipation
Correct response: Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas Explanation: ZES consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. Diarrhea and steatorrhea may be evident. The client may have co-existing parathyroid adenomas or hyperplasia and may therefore exhibit signs of hypercalcemia.
A client diagnosed with peptic ulcer disease has an H. pylori infection. The client is following a 2-week drug regimen that includes clarithromycin along with omeprazole and amoxicillin. How should the nurse instruct the client to take these medications? 1. Take the drugs at different times during the day. 2. Alternate the use of the drugs. 3. Discontinue all drugs if nausea occurs. 4. Take the drugs for the entire 2-week period.
Correct response: Take the drugs for the entire 2-week period. Explanation: The use of the triple therapy approach to the H. pylori infection has proved effective; therefore, the nurse advises the client to take the drugs as prescribed for the duration of the prescription. The nurse instructs the client to avoid alternating the use of the drugs and to take all medication at the same time, 3 times a day unless otherwise noted by the health care provider (HCP). Drugs have very few side effects; however, the nurse instructs the client to continue taking medications and contact the HCP if adverse effects occur.
he nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience 1. hemorrhage. 2. vomiting. 3. pain 2 to 3 hours after a meal. 4. weight loss.
Correct response: pain 2 to 3 hours after a meal. Explanation: The client with a gastric ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.
A client is readmitted with an exacerbation of celiac disease 2 weeks after discharge. Which statement by the client indicates the need for a dietary consult? 1. "I don't like oatmeal, so it doesn't matter that I can't have it." 2. "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." 3. "I don't understand why this happened again; I didn't travel out of the country." 4. "I don't understand this; I took the medication the doctor ordered and followed the diet."
Correct response: "I didn't eat anything I shouldn't have; I just ate roast beef on rye bread." Explanation: The client stating that he ate roast beef on rye bread indicates the need for a dietary consult because rye bread contains gluten, which must be eliminated from the client's diet. The client stating that he's followed the ordered medication regimen and diet doesn't suggest that the client needs a dietary consult; a treatment regimen consisting of medications to improve symptoms and dietary modification is necessary to treat celiac disease. The client stating that he hasn't traveled outside of the country doesn't suggest that dietary concerns exist. The client saying that he can't have oatmeal shows an understanding of the dietary restrictions necessary with celiac disease.
After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? 1. "A total serving should amount to be less than one cup." 2. "I need to drink 8 ounces of water before eating." 3. "I should pick cereals with less than 2 g of fiber per serving." 4. "I need to chew my food slowly and thoroughly."
Correct response: "I need to drink 8 ounces of water before eating." Explanation: After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withholding fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly, keeping total serving sizes to less than 1 cup, and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving.
After teaching the parents of a child with lactose intolerance about the disorder, the nurse determines that the teaching was effective when the mother used which statement to describe the condition? 1. "Inability to digest proteins completely." 2. "An allergy to lactose found in milk." 3. "Inability to digest fats completely." 4. "The lack of an enzyme to break down lactose."
Correct response: "The lack of an enzyme to break down lactose." Explanation: Lactose intolerance is not an allergy. Rather, it is caused by the lack of the digestive enzyme lactase. This enzyme, found in the intestines, is necessary for the digestion of lactose, the primary carbohydrate in cow's milk. Protein and fat digestion are not affected.
The nurse is evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? 1. Vomiting 2. Hemorrhage 3. Constipation 4. Awakening in pain
Correct response: Awakening in pain Explanation: The client with a duodenal ulcer is more likely to awaken with pain during the night than is the client with a gastric ulcer. Vomiting, constipation, diarrhea, and bleeding are symptoms common to both gastric and duodenal ulcers.
A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history: 1. Peptic ulcer disease 2. Coronary artery disease 3. Diabetes 4. Use of lithium
Correct response: Coronary artery disease Explanation: Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.
A morbidly obese client asks the nurse if medications are available to assist with weight loss. The nurse knows that the client would not be a candidate for phentermine if the following is part of the client's health history: 1. Peptic ulcer disease 2. Use of lithium 3. Diabetes 4. Coronary artery disease
Correct response: Coronary artery disease Explanation: Phentermine, which requires a prescription, stimulates central noradrenergic receptors, causing appetite suppression. It may increase blood pressure and should not be taken by people with a history of heart disease, uncontrolled hypertension, hyperthyroidism, or glaucoma.
A client sustained second- and third-degree burns over 30% of the body surface area approximately 72 hours ago. What type of ulcer should the nurse be alert for while caring for this client? 1. Peptic ulcer 2. Esophageal ulcer 3. Meckel's ulcer 4. Curling's ulcer
Correct response: Curling's ulcer Explanation: Curling's ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum. Peptic, esophageal, and Meckel's ulcers are not related to burn injuries.
hich of the following appears to be a significant factor in the development of gastric cancer? 1. Age 2. Ethnicity 3. Gender 4. Diet
Correct response: Diet Explanation: 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 reviews dietary guidelines with a client who had a gastric banding. Which teaching points are included? Select all that apply. 1. Avoid fruit drinks and soda. 2. Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. 3. Eat six meals a day. 4. Do not eat and drink at the same time. 5. Limit meal size to 450 to 500 mL.
Correct response: Do not eat and drink at the same time. Drink plenty of water, from 90 minutes after each meal to 15 minutes before each meal. Avoid fruit drinks and soda. Explanation: Total meal size should be restricted to less than 8 oz or 240 mL. Three meals a day are recommended.
The nursing student approaches his instructor to discuss the plan of care for his client diagnosed with peptic ulcer disease. The student asks what is the most common site for peptic ulcer formation? The instructor would state which one of the following? 1. Duodenum 2. Esophagus 3. Stomach 4. Pylorus
Correct response: Duodenum Explanation: Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.
A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? 1. Gastric secretion study 2. Endoscopy 3. Barium study of the upper gastrointestinal tract 4. Stool antigen test
Correct response: Endoscopy Explanation: Barium study of the upper GI tract may show an ulcer; however, endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions. Through endoscopy, a biopsy of the gastric mucosa and of any suspicious lesions can be obtained. Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies. 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.
As a nurse completes the admission assessment of a client admitted for gastric bypass surgery, the client states, "Finally! I'll be thin and able to eat without much concern." How should the nurse intervene? 1. Evaluate the client's understanding of the procedure. 2. Notify the health care provider that the client is eager to sign the consent form. 3. Rejoice with the client. 4. Ask the client about his or her plans for after surgery.
Correct response: Evaluate the client's understanding of the procedure. Explanation: The nurse should evaluate the client's understanding of the procedure. The client may not understand that surgery alone isn't a cure for obesity; lifestyle modifications and counseling are also necessary. Based on the client's comment, the client isn't fully informed; therefore, signing an informed consent form without further teaching would be inappropriate. Rejoicing with the client is inappropriate. Asking the client about plans for after surgery redirects the conversation away from the client's misinterpretation of the procedure.
A client has experienced symptoms of dumping syndrome following gastric surgery. To what physiologic phenomenon does the nurse attribute this syndrome? 1. Influx of extracellular fluid into the small intestine 2. Chronic malabsorption of iron and vitamins A and C 3. Irritation of the phrenic nerve due to diaphragmatic pressure 4. Reflux of bile into the distal esophagus
Correct response: Influx of extracellular fluid into the small intestine Explanation: The rapid bolus of hypertonic food from the stomach to the small intestines draws extracellular fluid into the lumen of the intestines to dilute the high concentrations of electrolytes and sugars, which results in intestinal dilation, increased intestinal transit, hyperglycemia, and the rapid onset of GI and vasomotor symptoms, which characterizes dumping syndrome. It is not a result of phrenic nerve irritation, malabsorption, or bile reflux.
A 66-year-old African-American client has recently visited a physician to confirm a diagnosis of gastric cancer. The client has a history of tobacco use and was diagnosed 10 years ago with pernicious anemia. He and his family are shocked about the possibility of cancer because he was asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On the basis of knowledge of disease progression, the nurse assumes that organs adjacent to the stomach are also affected. Which of the following organs may be affected? Choose all that apply. 1. Lungs 2. Liver 3. Duodenum 4. Pancreas 5. Bladder
Correct response: Liver Pancreas Duodenum Explanation: Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? 1. Hypertension 2. Bradypnea 3. Mental confusion 4. Bradycardia
Correct response: Mental confusion Explanation: Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? 1. Bradycardia 2. Bradypnea 3. Hypertension 4. Mental confusion
Correct response: Mental confusion Explanation: Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.
The nurse is teaching a client with peptic ulcer disease who has been prescribed misoprostol. What information from the nurse would be most accurate about misoprostol? 1. Decreases mucus production 2. Works best when taken on an empty stomach 3. Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) 4. Increases the speed of gastric emptying
Correct response: Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Misoprostol (Cytotec) is a synthetic prostaglandin that protects the gastric mucosa against ulceration and is used in clients who take NSAIDs. Misoprostol should be taken with food. It does not improve emptying of the stomach, and it increases (not decreases) mucus production.
Which of the following is the most successful treatment for gastric cancer? 1. Removal of the tumor 2. Radiation 3. Palliation 4. Chemotherapy
Correct response: Removal of the tumor Explanation: 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.
A nursing instructor is preparing a class about gastrointestinal intubation. Which of the following would the instructor include as reason for this procedure? Select all that apply. 1. Remove gas and fluids from the stomach 2. Evaluate for masses in the large colon 3. Diagnose gastrointestinal motility disorders .4 Flush ingested toxins from the stomach 5. Administer nutritional substances
Correct response: Remove gas and fluids from the stomach Diagnose gastrointestinal motility disorders Flush ingested toxins from the stomach Administer nutritional substances Explanation: Gastrointestinal intubation is used to decompress the stomach and remove gas and fluids, lavage the stomach and remove ingested toxins or other harmful materials, diagnose disorders of GI motility, administer medications and feedings, compress a bleeding site, and aspirate gastric contents for analysis. Because gastrointestinal intubation involves the insertion of a tube into the stomach, beyond the pylorus into the duodenum or jejunum, it could not be used to evaluate for masses in the large colon.
A nurse is monitoring a client with peptic ulcer disease. Which assessment findings would most likely indicate perforation of the ulcer? Select all that apply. 1. Mild epigastric pain 2. Hypotension 3. Tachycardia 4. A rigid, board-like abdomen 5. Diarrhea
Correct response: Tachycardia Hypotension A rigid, board-like abdomen Explanation: Signs and symptoms of perforation include sudden, severe upper abdominal pain (persisting and increasing in intensity); pain, 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 (board-like) abdomen; and hypotension and tachycardia, indicating shock. Perforation is a surgical emergency.
A healthcare provider prescribes a combination of drugs to treat reoccurring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client? 1. The antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori. 2. The proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori. 3. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. 4. The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori.
Correct response: The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. Explanation: The recommended combination of bismuth salts, antibiotics, and proton pump inhibitors will suppress or eradicate H. pylori. Prostaglandin E1 analogs enhance mucosal resistance to injury; they do not suppress or eradicate H. pylori.
A healthcare provider prescribes a combination of drugs to treat reoccurring peptic ulcer disease, and the client asks the nurse the reason for all the medications. What teaching should the nurse review with the client? 1. The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. 2. The antibiotics, prostaglandin E1 analogs, and bismuth salts will work together to suppress or eradicate H. pylori. 3. The prostaglandin E1 analogs, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. 4. The proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts will suppress or eradicate H. pylori.
Correct response: The bismuth salts, antibiotics, and proton pump inhibitors will work together to suppress or eradicate H. pylori. Explanation: The recommended combination of bismuth salts, antibiotics, and proton pump inhibitors will suppress or eradicate H. pylori. Prostaglandin E1 analogs enhance mucosal resistance to injury; they do not suppress or eradicate H. pylori.
A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: 1. a sedentary lifestyle and smoking. 2. a history of hemorrhoids and smoking. 3. alcohol abuse and smoking. 4. alcohol abuse and a history of acute renal failure.
Correct response: alcohol abuse and smoking. Explanation: The nurse should mention that risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse, smoking, and stress. A sedentary lifestyle and a history of hemorrhoids aren't risk factors for peptic ulcers. Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
The nurse monitors a client with cirrhosis for the development of hepatic encephalopathy. Which would be an indication that hepatic encephalopathy is developing? 1. labored respirations 2. decreased urine output 3. elevated blood pressure 4. decreased mental status
Correct response: decreased mental status Explanation: The client should be monitored closely for changes in mental status. Ammonia has a toxic effect on central nervous system tissue and produces an altered level of consciousness, marked by drowsiness and irritability. If this process is unchecked, the client may lapse into coma. Increasing ammonia levels are not detected by changes in blood pressure, urine output, or respirations.
A client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of 1. increasing fluid intake to prevent dehydration. 2. consuming a low-protein, high-fiber diet. 3. wearing an appliance pouch only at bedtime. 4. taking only enteric-coated medications.
Correct response: increasing fluid intake to prevent dehydration. Explanation: Because stool forms in the large intestine, an ileostomy typically drains liquid waste. To avoid fluid loss through ileostomy drainage, the nurse should instruct the client to increase fluid intake. The nurse should teach the client to wear a collection appliance at all times because ileostomy drainage is incontinent, to avoid high-fiber foods because they may irritate the intestines, and to avoid enteric-coated medications because the body can't absorb them after an ileostomy.
The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. Which action by the client demonstrates that the client has understood the recommended dietary changes? 1. Avoiding chocolate and coffee. 2. Avoiding steamed foods. 3. Eliminating spicy foods. 4. Eliminating cucumbers and other foods with seeds.
Correct response: Avoiding chocolate and coffee. Explanation: Chocolate, tea, cola, and caffeine lower esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them. Foods with seeds are restricted in diverticulosis. Steamed foods are encouraged to retain vitamins and decrease fat intake.
A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? 1. "Be sure to wear sunscreen while taking this medicine." 2. "Expect a metallic taste when taking this medicine, which is normal." 3. "Take the medication with milk." 4. "Do not drive when taking this medication."
Correct response: "Be sure to wear sunscreen while taking this medicine." Explanation: 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.
A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? 1. "I will have to take vitamin B12 shots up to 1 year after surgery." 2. "I'm going to visit my pastor weekly for a while." 3. "I will weight myself each day and record the weight." 4. "I will call my physician if I begin to have abdominal pain."
Correct response: "I will have to take vitamin B12 shots up to 1 year after surgery." Explanation: After a total gastrectomy, a client will need to take vitamin B12 shots for life. Dietary B12 is absorbed in the stomach, and the inability to absorb it could lead to pernicious anemia. Visiting clergy for emotional support is normal after receiving a cancer diagnosis. This action should be encouraged by the nurse. It's appropriate for the client to call the physician if he experiences signs and symptoms of intestinal blockage or obstruction, such as abdominal pain. Because a client with a total gastrectomy will receive enteral feedings or parenteral feedings, he should weigh himself each day and keep a record of the weights.
The nurse is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75? 1. Abdominal mass 2. Ascites 3. Hepatomegaly 4. Agitation
Correct response: Agitation Explanation: The nurse understands that agitation, along with confusion and restlessness, may be the only signs/symptoms seen of gastric cancer in the older client. Abdominal mass, hepatomegaly, and ascites may all be signs/symptoms of advanced gastric cancer.
The nurse is assessing an 80-year-old client for signs and symptoms of gastric cancer. The nurse differentiates which as a sign/symptom of gastric cancer in the geriatric client, but not in a client under the age of 75? 1. Abdominal mass 2. Hepatomegaly 3. Agitation 4. Ascites
Correct response: Agitation Explanation: The nurse understands that agitation, along with confusion and restlessness, may be the only signs/symptoms seen of gastric cancer in the older client. Abdominal mass, hepatomegaly, and ascites may all be signs/symptoms of advanced gastric cancer.
The nurse practitioner suspects that a patient may have a gastric ulcer after completing a history and physical exam. Select an indicator that can be used to help establish the distinction. 1. Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) 2. Amount of hydrochloric acid (HCL) secretion in the stomach 3. Presence of H. pylori 4. Patient's age
Correct response: Amount of hydrochloric acid (HCL) secretion in the stomach Explanation: A duodenal ulcer is characterized by hypersecretion of stomach acid, whereas a gastric ulcer evidences hyposecretion of stomach acid. The other three choices have similar characteristics in both types of ulcers.
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? 1. Clay-colored 2. Coffee-ground-like 3. Black and tarry 4. Bright red
Correct response: Black and tarry Explanation: 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? 1. Bloating after meals 2. Weight gain 3. Increased appetite 4. Abdominal pain below the umbilicus
Correct response: Bloating after meals Explanation: 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 patient comes to the clinic with the complaint, "I think I have an ulcer." What is a characteristic associated with peptic ulcer pain that the nurse should inquire about? Select all that apply. 1. Severe gnawing pain that increases in severity as the day progresses 2. Vomiting without associated nausea 3. Feeling of emptiness that precedes meals from 1 to 3 hours 4. Pain that radiates to the shoulder or jaw 5. Burning sensation localized in the back or mid-epigastrium
Correct response: Burning sensation localized in the back or mid-epigastrium Feeling of emptiness that precedes meals from 1 to 3 hours Severe gnawing pain that increases in severity as the day progresses Explanation: As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the mid-epigastrium or the back. Although vomiting is rare in uncomplicated peptic ulcer, it may be a symptom of a complication of an ulcer.
Which of the following appears to be a significant factor in the development of gastric cancer? 1. Diet 2. Ethnicity 3. Age 4. Gender
Correct response: Diet Explanation: 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.
A client has been taking famotidine at home. What teaching should the nurse include with the client? 1. Famotidine will inhibit gastric acid secretions. 2. Famotidine will improve the mixing of foods and gastric secretions. 3. Famotidine will neutralize acid in the stomach. 4. Famotidine will shorten the time required for digestion in the stomach.
Correct response: Famotidine will inhibit gastric acid secretions. Explanation: Famotidine is useful for treating and preventing ulcers and managing gastroesophageal reflux disease. It functions by inhibiting the action of histamine at the H-2 receptor site located in the gastric parietal cells, thus inhibiting gastric acid secretion. Famotidine will not neutralize acid in the stomach, but inhibits acid secretion. Famotidine will not shorten digestion time and will not improve food mixing with gastric secretions.
Which diagnostic test would be used first to evaluate a client with upper GI bleeding? 1. Endoscopy 2. Arteriography 3. Upper GI series 4. Hemoglobin and hematocrit
Correct response: Hemoglobin and hematocrit Explanation: The nurse assesses for faintness or dizziness and nausea, which may precede or accompany bleeding. It is important to monitor vital signs frequently and to evaluate for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production). If bleeding cannot be managed by the measures described, other treatment modalities such as endoscopy may be used to halt bleeding and avoid surgical intervention. There is debate regarding how soon endoscopy should be performed. Some clinicians believe endoscopy should be performed within the first 24 hours after hemorrhaging has ceased. Others believe endoscopy may be performed during acute bleeding, as long as the esophageal or gastric area can be visualized (blood may decrease visibility). An upper GI is less accurate than endoscopy and would not reveal a bleed. Arteriography is an invasive study associated with life-threatening complications and would not be used for an initial evaluation.
Results of a client barium swallow suggest that the client has GERD. The nurse is planning health education to address the client's knowledge of this new diagnosis. Which of the following should the nurse encourage? 1. Keeping the head of the bed partially elevated 2. Avoiding food or fluid intake after 6:00 PM 3. Eating several small meals daily rather than 3 larger meals 4. Drinking carbonated mineral water rather than soft drinks
Correct response: Keeping the head of the bed partially elevated Explanation: The client with GERD is encouraged to elevate the head of the bed at least 30 degrees. Frequent meals are not specifically encouraged and the client should avoid food and fluid within 2 hours of bedtime. All carbonated beverages should be avoided.
The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? 1. Nasogastric tube insertion 2. Stool specimen 3. Oral contrast 4. Pelvic x-ray
Correct response: Nasogastric tube insertion Explanation: The nurse anticipates an order for nasogastric tube insertion to decompress the stomach. Pelvic x-ray, oral contrast, and stool specimens are not indicated at this time.
A client has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. Which of the following actions should the nurse prioritize? 1. Teaching the client about necessary nutritional modification 2. Teaching the client about the etiology of gastritis 3. Providing the client with physical and emotional support 4. Helping the client weigh treatment options
Correct response: Providing the client with physical and emotional support Explanation: For acute gastritis, the nurse provides physical and emotional support and helps the client manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The scenario describes a newly diagnosed client; teaching about the etiology of the disease, lifestyle modifications, or various treatment options would be best provided at a later time.
A health care provider counsels a client about bariatric surgery and recommends the Roux-en-Y gastric bypass. What is the best response by the nurse to further explain this procedure to the client? 1. Gastroplasty with a vertical band allowing for a pouch with a 15 to 20 mL capacity 2. Gastric banding that incorporates a prosthetic device to restrict oral intake 3. Biliopancreatic diversion with a duodenal switch 4. Separation of the jejunum with an anastomosis
Correct response: Separation of the jejunum with an anastomosis Explanation: The Roux-en-Y gastric bypass is recommended for long-term weight loss because it uses a combined restrictive and malabsorptive procedure.
A nurse is completing a health history on a client whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the client's health problem? 1. Smokes one pack of cigarettes daily. 2. Takes over-the-counter antacids frequently throughout the day. 3. Reports a history of social drinking on a weekly basis. 4. Consumes one or more protein drinks daily.
Correct response: Smokes one pack of cigarettes daily. Explanation: Nicotine reduces secretion of pancreatic bicarbonate, which inhibits neutralization of gastric acid and can underlie gastritis. Protein drinks do not result in gastric inflammation. Antacid use is a response to experiencing symptoms of gastritis, not the etiology of gastritis. Alcohol ingestion can lead to gastritis; however, this generally occurs in clients with a history of consumption of alcohol on a daily basis.
A client with peptic ulcer disease wants to know nonpharmacologic ways to prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. 1. Substituting decaffeinated products for all forms of coffee 2. Following a regular schedule for rest, relaxation, and meals 3. Smoking cessation 4. Eating whenever hungry 5. Avoidance of alcohol
Correct response: Smoking cessation Substituting decaffeinated products for all forms of coffee Avoidance of alcohol Following a regular schedule for rest, relaxation, and meals Explanation: The likelihood of recurrence is reduced if the client avoids smoking, coffee (including decaffeinated coffee) and other caffeinated beverages, and alcohol. It is important to counsel the client to eat meals at regular times and in a relaxed setting and to avoid overeating.
The nurse cares for a client after a gastroscopy for which the client received sedation. The nurse should report which finding to the physician? 1. loss of gag reflex 2. difficulty swallowing 3. drowsiness 4. minor throat pain
Correct response: difficulty swallowing Explanation: The nurse should report difficulty swallowing to the physician as this may be a sign of perforation. Loss of gag reflex, minor throat pain, and drowsiness are expected findings after a gastroscopy for which the client received sedation and therefore there is no need to report to the physician.
A client is prescribed tetracycline to treat peptic ulcer disease. Which instruction would the nurse give the client? 1. "Take the medication with milk." 2. "Expect a metallic taste when taking this medicine, which is normal." 3. "Do not drive when taking this medication." 4. "Be sure to wear sunscreen while taking this medicine."
Correct response: "Be sure to wear sunscreen while taking this medicine." Explanation: 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.
After teaching a client who has had a Roux-en-Y gastric bypass, which client statement indicates the need for additional teaching? 1. "I need to chew my food slowly and thoroughly." 2. "I need to drink 8 ounces of water before eating." 3. "A total serving should amount to be less than one cup." 4. "I should pick cereals with less than 2 g of fiber per serving."
Correct response: "I need to drink 8 ounces of water before eating." Explanation: After a Roux-en-Y gastric bypass, the client should not drink fluids with meals, withholding fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly, keeping total serving sizes to less than 1 cup, and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving.
Which is a true statement regarding the nursing considerations in administration of metronidazole? 1. It may cause weight gain. 2. Metronidazole decreases the effect of warfarin. 3. It leaves a metallic taste in the mouth. 4. The drug should be given before meals.
Correct response: It leaves a metallic taste in the mouth. Explanation: Metronidazole leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease gastrointestinal upset. Metronidazole increases the blood-thinning effects of warfarin.
A nurse is caring for a client with an endotracheal tube who receives enteral feedings through a feeding tube. Before each tube feeding, the nurse checks for tube placement in the stomach as well as residual volume. The purpose of the nurse's actions is to prevent 1. aspiration. 2. abdominal distention. 3. diarrhea. 4. gastric ulcers.
Correct response: an 80-year-old client who has poor oral hygiene and is dehydrated Explanation: Parotitis is inflammation of the parotid gland. Although any of the clients listed could develop parotitis, given the data provided, the one most likely to develop parotitis is the elderly client who is dehydrated with poor oral hygiene. Any client who experiences poor oral hygiene is at risk for developing parotitis. To help prevent parotitis, it is essential for the nurse to ensure the client receives oral hygiene at regular intervals and has an adequate fluid intake.
The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience 1. weight loss. 2. hemorrhage. 3. pain 2 to 3 hours after a meal. 4. vomiting.
Correct response: pain 2 to 3 hours after a meal. Explanation: The client with a gastric ulcer often awakens between 1 and 2 with pain, and ingestion of food brings relief. Vomiting is uncommon in the client with duodenal ulcer. Hemorrhage is less likely in the client with duodenal ulcer than the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.
After teaching the parents of an infant diagnosed with Hirschsprung's disease, the nurse determines that the parents understand the diagnosis when the parent makes which statement? 1. "A section of the colon is constricted." 2. "There is weakened area in the colon that is inflamed." 3. "The nerves at the end of the large colon are missing." 4. "There are congenital polyps obstructing the colon."
Correct response: "The nerves at the end of the large colon are missing." Explanation: The primary defect in Hirschsprung's disease is an absence of autonomic parasympathetic ganglion cells in the distal portion of the colon. Thus, the nerves at the end of the large colon are missing. Constipation is caused by decreased peristalsis, not a physical obstruction like polyps. The colon typically enlarges giving rise to the name "megacolon" versus being constricted. Weakened areas of the colon are associated with diverticulosis.
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? 1. The vagus nerve is cut and gastric drainage is established. 2. A sectioned portion of the stomach is joined to the jejunum. 3. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. 4. The antral portion of the stomach is removed and a vagotomy is performed.
Correct response: A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. Explanation: A Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.
A client with gastric cancer is having a resection. What is the nursing management priority for this client? 1. Teaching about radiation treatment 2. Correcting nutritional deficits 3. Preventing deep vein thrombosis (DVT) 4. Discharge planning
Correct response: Correcting nutritional deficits Explanation: Clients with gastric cancer commonly have nutritional deficits and may have cachexia. Therefore, correcting nutritional deficits is a top priority. Discharge planning before surgery is important, but correcting the nutritional deficits is a higher priority. Radiation therapy hasn't been proven effective for gastric cancer, and teaching about it preoperatively wouldn't be appropriate. Preventing DVT isn't a high priority before surgery, but it assumes greater importance after 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? 1. Bile reflux 2. Celiac disease 3. Dumping syndrome 4. Gastric outlet obstruction
Correct response: Dumping syndrome Explanation: 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 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? 1. Celiac disease 2. Gastric outlet obstruction 3. Bile reflux 4. Dumping syndrome
Correct response: Dumping syndrome Explanation: 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 nurse is providing follow-up teaching at a clinic visit for a client recovering from gastric resection. The client reports sweating, diarrhea, nausea, palpitations, and the desire to lie down 15 to 30 minutes after meals. Based on the client's assessment, what will the nurse suspect? 1. A normal reaction to surgery 2. Peritonitis 3. Dehiscence of the surgical wound 4. Dumping syndrome
Correct response: Dumping syndrome Explanation: 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, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.
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? 1. Hematemesis 2. Bradycardia 3. Hypertension 4. Polyuria
Correct response: Hematemesis Explanation: 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.
A client is recovering from gastric surgery. Toward what goal should the nurse progress the client's enteral intake? 1. Three meals and three snacks and 120 mL fluid daily 2. Three meals and 120 ml fluid daily 3. Six small meals and 120 mL fluid daily 4. Six small meals daily with 120 mL fluid between meals
Correct response: Six small meals daily with 120 mL fluid between meals Explanation: 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.
A nursing student is caring for a client with gastritis. Which of the following would the student recognize as a common cause of gastritis? Choose all that apply. 1. Overuse of aspirin 2. Participation in highly competitive sports 3. DASH diet 4. Irritating foods 5. Ingestion of strong acids
Correct response: Ingestion of strong acids Irritating foods Overuse of aspirin Explanation: Acute gastritis is often caused by dietary indiscretion-a 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. A DASH diet is an acronym for Dietary Approaches to Stop Hypertension, which would not cause gastritis. Participation in competitive sports also would not cause gastritis.
Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? 1. Bradycardia 2. Mental confusion 3. Bradypnea 4. Hypertension
Correct response: Mental confusion Explanation: Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.
Which is a true statement regarding gastric cancer? 1. Most clients are asymptomatic during the early stage of the disease. 2. Women have a higher incidence of gastric cancer. 3. Most cases are discovered before metastasis. 4. The prognosis for gastric cancer is good.
Correct response: Most clients are asymptomatic during the early stage of the disease. Explanation: Most clients are asymptomatic during the early stage of the disease. Men have a higher incidence of gastric cancer. The prognosis is poor because the diagnosis is usually made late because most clients are asymptomatic during the early stage. Most cases of gastric cancer are discovered only after local invasion has advanced or metastases are present.
A client is prescribed a histamine (H2)-receptor antagonist. The nurse understands that this might include which medication(s)? Select all that apply. 1. Nizatidine 2. Cimetidine 3. Esomeprazole 4. Famotidine 5. Lansoprazole
Correct response: Nizatidine Famotidine Cimetidine Explanation: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton-pump inhibitors.
A client is preparing for discharge to home following a partial gastrectomy and vagotomy. Which is the best rationale for the client being taught to lie down for 30 minutes after each meal? 1. Removes tension on internal suture line 2. Provides much needed rest 3. Slows gastric emptying 4. Allows for better absorption of vitamin B12
Correct response: Slows gastric emptying Explanation: Dumping syndrome is a common complication following subtotal gastrectomy. To avoid the rapid emptying of stomach contents, resting after meals can be helpful. Promoting rest after a major surgery is helpful in recovery but not the reason for resting after meals. Following this type of surgery, clients will have a need for vitamin B12 supplementation due to absence of production of intrinsic factor in the stomach. Resting does not increase absorption of B12 or remove tension on suture line.
The health care provider prescribes sulfasalazine for the client with ulcerative colitis. Which instruction should the nurse give the client about taking this medication? 1. Avoid taking it with food. 2. Take the total dose at bedtime. 3. Take it with a full glass (240 mL) of water. 4. Stop taking it if urine turns orange-yellow
Correct response: Take it with a full glass (240 mL) of water. Explanation: Adequate fluid intake of at least eight glasses a day prevents crystalluria and stone formation during sulfasalazine therapy.Sulfasalazine can cause gastrointestinal distress and is best taken after meals and in equally divided doses.Sulfasalazine gives alkaline urine an orange-yellow color, but it is not necessary to stop the drug when this occurs.
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? 1. Dehiscence of the surgical wound 2. A normal reaction to surgery 3. Vasomotor symptoms associated with dumping syndrome 4. Peritonitis
Correct response: Vasomotor symptoms associated with dumping syndrome Explanation: 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, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.
TPN is prescribed for a client with Crohn's disease. What indicates to the nurse that the TPN has been effective? The client: 1. is not in metabolic acidosis. 2. has met nutritional needs. 3. is in a negative nitrogen balance. 4. is hydrated.
Correct response: has met nutritional needs. Explanation: The goal of TPN is to meet the client's nutritional needs. TPN is not used to treat metabolic acidosis; ketoacidosis can actually develop as a result of administering TPN. TPN is a hypertonic solution containing carbohydrates, amino acids, electrolytes, trace elements, and vitamins. It is not used to meet the hydration needs of clients. TPN is administered to provide a positive nitrogen balance.
A nurse is caring for a client after a hemorrhoidectomy. Which order would the nurse question on the medical record? 1. fluid encouragement 2. low-fiber diet 3. stool softener daily 4. warm sitz baths as needed
Correct response: low-fiber diet Explanation: The nurse would question a low-fiber diet. Increased fluids and fiber would be encouraged to prevent constipation. Warm sitz baths would decrease rectal muscle spasms. A stool softener would be indicated to prevent straining.
Which condition is most likely to have a nursing diagnosis of fluid volume deficit? 1. appendicitis 2. gastric ulcer 3. pancreatitis 4. cholecystitis
Correct response: pancreatitis Explanation: Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. Appendicitis, cholecystitis, and gastric ulcer are less likely to exhibit fluid volume deficit.
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? 1. The vagus nerve is cut and gastric drainage is established. 2. The antral portion of the stomach is removed and a vagotomy is performed. 4. A sectioned portion of the stomach is joined to the jejunum. 5. A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.
Correct response: A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. Explanation: A Billroth I procedure involves removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.
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.) 1. "Is it possible that you are overusing aspirin." 2. "It can be caused by ingestion of strong acids." 3. "It is probably your nerves." 4. "It is a hereditary disease." 5. "You may have ingested some irritating foods."
Correct response: "It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." Explanation: 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 laboratory finding is expected when a client has diverticulitis? 1. elevated red blood cell count 2. decreased platelet count 3. elevated white blood cell count 4. elevated serum blood urea nitrogen concentration
Correct response: elevated white blood cell count Explanation: Because of the inflammatory nature of diverticulitis, the nurse would anticipate an elevated white blood cell count. The remaining laboratory findings are not associated with diverticulitis.Elevated red blood cell counts occur in clients with polycythemia vera or fluid volume deficit.Decreased platelet counts can occur as a result of aplastic anemias or malignant blood disorders, as an adverse effect of some drugs, and as a result of some heritable conditions.Elevated serum blood urea nitrogen concentration is usually associated with renal conditions.
A client is admitted with a diagnosis of ulcerative colitis. The nurse should assess the client for: 1. constipation. 2. alternating periods of constipation and diarrhea. 3. bloody, diarrheal stools. 4. steatorrhea.
Correct response: bloody, diarrheal stools. Explanation: Diarrhea is the primary symptom of ulcerative colitis. It is profuse and severe; the client may pass as many as 15 to 20 watery stools per day. Stools may contain blood, mucus, and pus. The frequent diarrhea is often accompanied by anorexia and nausea.Constipation is not a sign or symptom of ulcerative colitis.Steatorrhea (fatty stools) is more typical of pancreatitis and cholecystitis.Alternating diarrhea and constipation is associated with irritable bowel syndrome.
A client comes to the clinic after developing a headache, abdominal pain, nausea, hiccupping, and fatigue about 2 hours ago. The client tells the nurse that the last food was buffalo chicken wings and beer. Which medical condition does the nurse find to be most consistent with the client's presenting problems? 1. Gastric ulcer 2. Acute gastritis 3. Gastric cancer 4. Duodenal ulcer
Correct response: Acute gastritis Explanation: A client with acute gastritis may have a rapid onset of symptoms, including abdominal discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccupping, which can last from a few hours to a few days. Acute gastritis is often caused by dietary indiscretion-a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. A client with a duodenal ulcer will present with heartburn, nausea, excessive gas and vomiting. A client with gastric cancer will have persistent symptoms of nausea and vomiting, not sudden symptoms. A client with a gastric ulcer will have bloating, nausea, and vomiting, but not necessarily hiccups.
A client has a family history of stomach cancer. Which factor would further increase the client's risk for developing gastric cancer? Select all that apply. 1. Female gender 2. Previous infection with H. pylori 3. Age 55 years 4. Caucasian ancestry 5. High intake of fruits and vegetables
Correct response: Age 55 years Previous infection with H. pylori Explanation: The typical client with gastric cancer is between 40 and 70 years, but gastric cancer can occur in younger people. Men have a higher incidence of gastric cancer than women. Native Americans, Hispanic Americans, and African Americans are twice as likely as Caucasian Americans to develop gastric cancer. A diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer. Other factors related to the incidence of gastric cancer include chronic inflammation of the stomach, H. pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, subtotal gastrectomy more than 20 years ago, and genetics.
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? 1. Place the client in the high-Fowler's position. 2. Assess the client's abdomen and vital signs. 3. Irrigate the client's NG tube. 4. Notify the health care provider.
Correct response: Assess the client's abdomen and vital signs. Explanation: 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.
When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? 1. Place the client in the high-Fowler's position. 2. Notify the health care provider. 3. Assess the client's abdomen and vital signs. 4. Irrigate the client's NG tube.
Correct response: Assess the client's abdomen and vital signs. Explanation: 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 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? 1. Hypertension 2. Hematemesis 3. Polyuria 4. Bradycardia
Correct response: Hematemesis Explanation: 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.
A client with severe peptic ulcer disease has undergone surgery and is several hours postoperative. During assessment, the nurse notes that the client has developed cool skin, tachycardia, labored breathing, and appears to be confused. Which complication has the client most likely developed? 1. Perforation 2. Penetration 3. Hemorrhage 4. Pyloric obstruction
Correct response: Hemorrhage Explanation: Signs of hemorrhage following surgery include cool skin, confusion, increased heart rate, labored breathing, and blood in the stool. Signs of penetration and perforation are severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate. Indicators of pyloric obstruction are nausea, vomiting, distended abdomen, and abdominal pain.
Review the following four examples of ideal body weight (IBW), actual weight, and body mass index (BMI). Using three criteria for each example, select the body weight that indicates morbid obesity. 1. IBW = 132 lbs; weight = 184 lbs; BMI = 28 kg/m2 2. IBW = 150 lbs; weight = 190 lbs; BMI = 26 kg/m2 3. IBW = 175 lbs; weight = 265 lbs; BMI = 29 kg/m2 4. IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2
Correct response: IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2 Explanation: The criteria for morbid obesity are a body weight that is twice IBW and a BMI that exceeds 30 kg/m2.
A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? 1. Regular diet 2. Clear liquids 3. Skim milk 4. Nothing by mouth
Correct response: Nothing by mouth Explanation: Shock and bleeding must be controlled before oral intake, so the client should receive nothing by mouth. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric acid production, which could prolong bleeding. A clear liquid diet is the first diet offered after bleeding and shock are controlled.
A nurse practitioner prescribes drug therapy for a patient with peptic ulcer disease. Choose the drug that can be used for 4 weeks and has a 90% chance of healing the ulcer. 1. Omeprazole 2. Nizatidine 3. Cimetidine 4. Famotidine
Correct response: Omeprazole Explanation: Omeprazole (Prilosec) is a proton pump inhibitor that, if used according to the health care provider's directions, will result in healing in 90% of patients. The other drugs are H2 receptor antagonists that need to be used for 6 weeks.
A health care provider counsels a client about bariatric surgery and recommends the Roux-en-Y gastric bypass. What is the best response by the nurse to further explain this procedure to the client? 1. Biliopancreatic diversion with a duodenal switch 2. Gastric banding that incorporates a prosthetic device to restrict oral intake 3. Gastroplasty with a vertical band allowing for a pouch with a 15 to 20 mL capacity 4. Separation of the jejunum with an anastomosis
Correct response: Separation of the jejunum with an anastomosis Explanation: The Roux-en-Y gastric bypass is recommended for long-term weight loss because it uses a combined restrictive and malabsorptive procedure.
Which is an accurate statement regarding gastric cancer? 1. The incidence of stomach cancer continues to decrease in the United States. 2. Most gastric cancer-related deaths occur in people younger than 40 years. 3. A diet high in smoked foods and low in fruits and vegetables may decrease the risk of gastric cancer. 4. Females have a higher incidence of gastric cancers than males.
Correct response: The incidence of stomach cancer continues to decrease in the United States. Explanation: While the incidence in the United States continues to decrease, gastric cancer still accounts for 10,700 deaths annually. While gastric cancer deaths occasionally occur in younger people, most occur in people older than 40 years of age. Males have a higher incidence of gastric cancers than females. More accurately, a diet high in smoked foods and low in fruits and vegetables may increase the risk of gastric cancer.
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? 1. Vasomotor symptoms associated with dumping syndrome 2. Peritonitis 3. A normal reaction to surgery 4. Dehiscence of the surgical wound
Correct response: Vasomotor symptoms associated with dumping syndrome Explanation: 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, board-like abdomen, tenderness, and fever. The client's signs and symptoms aren't a normal reaction to surgery.
The nurse is developing a plan of care for a client with Crohn's disease who is receiving total parenteral nutrition (TPN). Which interventions should the nurse include? Select all that apply. 1. Weigh the client daily. 2. Monitor vital signs once a shift. 3. Tape all IV tubing connections securely. 4. Monitor the IV infusion rate hourly. 5. Change the central venous line dressing daily.
Correct response: Weigh the client daily. Monitor the IV infusion rate hourly. Tape all IV tubing connections securely. Explanation: When caring for a client who is receiving TPN, the nurse should plan to weigh the client daily, monitor the IV fluid infusion rate hourly (even when using an IV fluid pump), and securely tape all IV tubing connections to prevent disconnections. Vital signs should be monitored at least every 4 hours to facilitate early detection of complications. It is recommended that the IV dressing be changed once or twice per week or when it becomes soiled, loose, or wet.
A nurse caring for a client with small-bowel obstruction should plan to implement which nursing intervention first? administering pain medication administering I.V. fluids preparing to insert a nasogastric (NG) tube obtaining a blood sample for laboratory studies
Correct response: administering I.V. fluids Explanation: The nurse should first administer I.V. infusions containing normal saline solution and potassium to maintain fluid and electrolyte balance. For the client's comfort and to assist in bowel decompression, the nurse should prepare to insert an NG tube next. A blood sample is then obtained for laboratory studies to help diagnose bowel obstruction and guide treatment. Blood studies usually include a complete blood count, serum electrolyte levels, and blood urea nitrogen level. Pain medication commonly is withheld until obstruction is diagnosed because analgesics can decrease intestinal motility.
A client who had a cholecystectomy has a T-tube for drainage. The nurse measures the amount of bile drainage from the T tube at the end of each shift. How should the nurse record the drainage? 1. charting it separately on the output record 2. subtracting it from the total intake for each day 3. adding it to the client's urine output 4. adding it to the amount of wound drainage
Correct response: charting it separately on the output record Explanation: T-tube bile drainage is recorded separately on the output record. Adding the t-tube drainage to the urine output or wound drainage makes it difficult to accurately determine the amounts of bile, urine, or drainage. The client's total intake will be incorrect if drainage is subtracted from it.
When preparing a client for a scheduled colonoscopy, the nurse should tell the client that this procedure will involve: 1. cleansing the bowel with laxatives. 2. placing the client on a full-liquid diet 48 hours before the procedure. 3. administering meperidine IM to prevent pain during the procedure. 4. administering an antibiotic to decrease the risk of infection.
Correct response: cleansing the bowel with laxatives. Explanation: A colonoscopy is the visual examination of the large bowel using a flexible endoscope inserted into the client's rectum. Typically, the client will be placed on a liquid diet 24 hours before the procedure and kept NPO after midnight the night before the procedure. The bowel is cleansed through the use of laxatives. A client does not usually receive antibiotics before a colonoscopy. However, antibiotics may be used prior to bowel surgery to decrease the risk of infection. A sedative or analgesic may be given IV to decrease anxiety during the procedure and promote conscious sedation. However, the nurse would not administer an opioid when preparing this client.
A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to: 1. drink liquids only between meals. 2. drink liquids only with meals. 3. don't drink liquids 2 hours before meals. 4. restrict fluid intake to 1 qt (1,000 ml)/day.
Correct response: drink liquids only between meals. Explanation: 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.
The nurse is caring for a client recently diagnosed with hepatitis C. In reviewing the client's history, what information will be most helpful as the nurse develops a teaching plan? The client: 1. is a scientist and is frequently exposed to multiple chemicals. 2. has a history of exercise-induced asthma. 3. has a known history of sexually transmitted disease. 4. traveled to Central America recently and ate uncooked vegetables.
Correct response: has a known history of sexually transmitted disease. Explanation: Although primarily bloodborne, unprotected sex with multiple partners and/or a history of sexually transmitted disease are risk factors for transmission of the hepatitis C virus. Other risk factors include blood transfusions, past treatment with chronic hemodialysis, being a child born to women infected with hepatitis C virus, past/current illicit IV drug use or needle-stick injuries to healthcare workers. It is important for the nurse to be aware of the client's history in order to help determine the client's level of understanding of the disease, promote a healthy lifestyle, and discuss the role of viral transmission of the disease.
Before abdominal surgery for an intestinal obstruction, the nurse monitors the client's urine output and finds that the total output for the past 2 hours was 35 mL. The nurse then assesses the client's total intake and output over the last 24 hours and notes 2,000 mL of IV fluid for intake, 500 mL of drainage from the nasogastric tube, and 700 mL of urine for a total output of 1,200 mL. How should the nurse interpret these findings? 1. extension of the obstruction 2. the nasogastric tube not draining well 3. decreased renal function 4. inadequate fluid replacement
Correct response: inadequate fluid replacement Explanation: Considering that there is usually 1 L of insensible fluid loss, this client's output exceeds his intake (intake, 2,000 mL; output, 2,200 mL), indicating deficient fluid volume. The kidneys are concentrating urine in response to low circulating volume, as evidenced by a urine output of less than 30 mL/h. This indicates that increased fluid replacement is needed. Decreasing urine output can be a sign of decreased renal function, but the data provided suggest that the client is dehydrated. Pain does not affect urine output. There are no data to suggest that the obstruction has worsened.
The nurse is reviewing laboratory data for a client with pancreatic cancer. Which finding does the nurse prioritize as requiring notification of the health care provider? 1. creatinine: 2.0 mg/dl (176.8 µmol/L) 2. potassium: 2.2 mEq/L (2.2 mmol/L) 3. sodium: 136 mEq/L (136 mmol/L) 4. glucose, fasting: 204 mg/dl (11.32 mmol/L)
Correct response: potassium: 2.2 mEq/L (2.2 mmol/L) Explanation: The nurse should identify potassium 2.2 mEq/L as critical because a normal potassium level is 3.8 to 5.5 mEq/L. Severe hypokalemia can cause cardiac and respiratory arrest, possibly leading to death. Hypokalemia also depresses the release of insulin and results in glucose intolerance. The glucose level is above normal (normal is 75 to 110 mg/dl). The sodium level is normal (135-145 mEq/L). The creatinine is elevated (normal is 0.8 to 1.4 mg/dl), but this would not be a priority to report at this time.
