Prep U 47 (hard questions)

A client with acute gastritis asks the nurse what might have caused the problem. Which of the following are possible causes? A. Overuse of allergy medicine B. Excessive alcohol intake C. Drinking fruit juices D. Dietary indiscretion E. Radiation therapy

B,D,E R: Possible causes of gastritis include dietary indiscretion, overuse of aspirin and other nonsteroidal anti-inflammatory drugs, excessive alcohol intake, bile reflux, and radiation therapy. Allergy medicine and fruit juices are not causes of acute gastritis.

Which of the following statements correctly identifies a difference between duodenal and gastric ulcers? A. Vomiting is uncommon in patients with duodenal ulcers. B. A gastric ulcer is caused by hypersecretion of stomach acid. C. Weight gain may occur with a gastric ulcer. D. Malignancy is associated with duodenal ulcer.

A

A client with peptic ulcer disease wants to know nonpharmacological ways that he can prevent recurrence. Which of the following measures would the nurse recommend? Select all that apply. A. Smoking cessation B. Avoidance of alcohol C. Following a regular schedule for rest, relaxation, and meals D. Substitution of coffee with decaffeinated products E. Eating whenever hungry

A, B, C R: 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 is teaching a client with peptic ulcer disease who has been prescribed misoprostol (Cytotec). What information from the nurse would be most accurate about misoprostol? A. Increases the speed of gastric emptying B. Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) C. Decreases mucus production D. Works best when taken on an empty stomach

B R: Misoprostol 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.

A client with a peptic ulcer is diagnosed with Heliobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole (Flagyl), omeprazole (Prilosec), and clarithromycin (Biaxin). Which statement by the client indicates the best understanding of the medication regimen? A. "These medications will coat the ulcer and decrease the acid producation in my stomach." B. "I should take these medications only when I have pain from my ulcer." C. "The medications will kill the bacteria and stop the acid production." D. "My ulcer will heal because these medications will kill the bacteria."

C R: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 (eg, metronidazole [Flagyl] or amoxicillin [Amoxil] and clarithromycin [Biaxin]) plus a proton-pump inhibitor (eg, 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 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? A. Esophagus B. Duodenum C. Pylorus D. Stomach

B R:Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin.

The health care provider prescribes a combination of three drugs to treat peptic ulcer disease. The nurse, preparing to review the drug actions and side effects with the patient, understands that the triple combination should be in which of the following order? A. Prostaglandin E1 analogs, antibiotics, and proton pump inhibitors B. Antibiotics, prostaglandin E1 analogs, and bismuth salts C. Proton pump inhibitors, prostaglandin E1 analogs, and bismuth salts D. Bismuth salts, antibiotics, and proton pump inhibitors

D

A patient has been diagnosed with acute gastritis and asks the nurse what could have caused it. What is the best response by the nurse? (Select all that apply.) A. "Is it possible that you are overusing aspirin." B. "It can be caused by ingestion of strong acids." C. "It is a hereditary disease." D. "You may have ingested some irritating foods." E. "It is probably your nerves."

A,B, D R: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.

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

B R:Symptoms of progressive disease include bloating after meals, weight loss, abdominal pain above the umbilicus, and loss or decrease in appetite.

A client with gastric cancer is having a resection. What is the nursing management priority for this client? A. Preventing deep vein thrombosis (DVT) B. Teaching about radiation treatment C. Discharge planning D. Correcting nutritional deficits

D R: 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 nurse is caring for a patient who has been diagnosed with gastritis. To promote fluid balance when treating gastritis, the nurse knows that what minimal daily intake of fluids is required? A. 2.5 L B. 1.0 L C. 2.0 L D. 1.5 L

D R:Daily fluid intake and output are monitored to detect early signs of dehydration (minimal fluid intake of 1.5 L/day, minimal output of 0.5 mL/kg/h).

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. A. Cimetidine (Tagamet) B. Famotidine (Pepcid) C. Ranitidine (Zantac) D. Omeprazole (Prilosec)

D R: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.

Which of the following clients is at highest risk for peptic ulcer disease? A. A 19-year-old female college student B. A 72-year-old grandfather of four C. A 31-year-old pregnant woman D. A 52-year-old male accountant

D R:Peptic ulcer disease occurs with the greatest frequency in people 40 and 60 years old. It is relatively uncommon in women of childbearing age, but it has been observed in children and even in infants. After menopause, the incidence of peptic ulcers in women is almost equal to that in men.

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. A. Duodenum B. Lungs C. Liver D. Pancreas E. Bladder

A,C,D R: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.

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. A. Gastrin-secreting tumors of the pancreas B. Constipation C. Severe peptic ulcers D. Extreme gastric hyperacidity E. Hypocalcemia

A,C,D R: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 has given a confirmed diagnosis of gastric cancer. Two more procedures may be performed to assess tumor depth and lymph node involvement and surgical resectability. Which two are the procedures? Choose the two that apply. A. Esophagogastroduodenoscopy (EGD) B. Endoscopic ultrasound C. Computed tomography (CT) D. Barium x-ray of the upper GI tract

B, C R: Esophagogastroduodenoscopy for biopsy and cytologic washings is the diagnostic study of choice, and a barium x-ray examination of the upper GI tract may also be performed. Endoscopic ultrasound is an important tool to assess tumor depth and any lymph node involvement. Pelvic ultrasound is not used to confirm the diagnosis of gastric cancer.

Which of the following is a true statement regarding the nursing considerations in administration of Metronidazole (Flagyl)? A. Flagyl decreases the effect of Coumadin. B. It may cause weight gain. C. The drug should be given prior to meals. D. It leaves a metallic taste in the mouth.

D R:Flagyl leaves a metallic taste in the mouth. It may cause anorexia and should be given with meals to decrease GI upset. Flagyl increases the blood-thinning effects of warfarin (Coumadin).