Week 7: Hinkle Chapter 40 Prep U

A client comes to the clinic reporting pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the client has a peptic ulcer? "Does your pain resolve when you have something to eat?" "Do over-the-counter pain medications help your pain?" "Does your pain get worse if you get up and do some exercise?" "Do you find that your pain is worse when you need to have a bowel movement?"

"Does your pain resolve when you have something to eat?" Explanation: Pain relief after eating is associated with peptic ulcers. The pain of peptic ulcers is generally unrelated to activity or bowel function and may or may not respond to analgesics.

A client recovering from the removal of a gastric tumor asks why radiation therapy is needed. Which response will the nurse provide? "It is to heal the wound faster." "It is to kill any remaining cancer cells." "It is to reduce your need for medication." "It is to prevent the development of a wound infection."

"It is to kill any remaining cancer cells." Explanation: Radiation therapy may also be used alone or along with chemotherapy before surgery to decrease the size of the tumor, or after surgery to destroy any remaining cancer cells and to delay or prevent reoccurrence of the cancer. Radiation therapy is not used to heal the surgical wound, reduce the need for medication, or to prevent the development of a wound infection.

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? "My ulcer will heal because these medications will kill the bacteria." "I should take these medications only when I have pain from my ulcer." "The medications will kill the bacteria and stop the acid production." "These medications will coat the ulcer and decrease the acid production in my stomach."

"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.

A client with peptic ulcer disease must begin triple medication therapy. For how long will the client follow this regimen? 4 to 6 days 7 to 9 days 10 to 14 days 15 to 20 days

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 nursing student is preparing a teaching plan about peptic ulcer disease. The student knows to include teaching about the percentage of clients with peptic ulcers who experience bleeding. The percentage is Less than 5% 15% 25% Greater than 50%

15% Explanation: Fifteen percent of clients with peptic ulcer experience bleeding.

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

450 mL Explanation: A residual of greater than 400 mL strongly suggests obstruction.

A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed? A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum. A sectioned portion of the stomach is joined to the jejunum. The antral portion of the stomach is removed and a vagotomy is performed. The vagus nerve is cut and gastric drainage is established.

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 vagotomy severs the vagus nerve; a Billroth I procedure may be performed in conjunction with a vagotomy. If the remaining part of the stomach is anastomosed to the jejunum, the procedure is a Billroth II.

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. Amount of hydrochloric acid (HCL) secretion in the stomach Sensitivity to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) Presence of H. pylori Patient's age

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.

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? Notify the health care provider. Irrigate the client's NG tube. Place the client in the high-Fowler's position. Assess the client's abdomen and vital signs.

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 evaluating a client's ulcer symptoms to differentiate ulcer as duodenal or gastric. Which symptom should the nurse at attribute to a duodenal ulcer? Vomiting Hemorrhage Awakening in pain Constipation

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

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.

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

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.

Which ulcer is associated with extensive burn injury? Cushing ulcer Curling ulcer Peptic ulcer Duodenal ulcer

Curling ulcer Explanation: Curling ulcer is frequently observed about 72 hours after extensive burns and involves the antrum of the stomach or the duodenum.

Clients with Type O blood are at higher risk for which of the following GI disorders? Gastric cancer Duodenal ulcers Esophageal varices Diverticulitis

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.

Which term refers to the first portion of the small intestine? Pylorus Peritoneum Omentum Duodenum

Duodenum Explanation: The duodenum is the first portion of the small intestine, between the stomach and the jejunum. The pylorus is the opening between the stomach and duodenum. The peritoneum is the thin membrane that lines the inside the wall of the abdomen and covers all the abdominal organs. The omentum is the fold of the peritoneum that surrounds the stomach and other organs of the abdomen.

Which medication is classified as a histamine-2 receptor antagonist? Famotidine Lansoprazole Metronidazole Esomeprazole

Famotidine Explanation: Famotidine is a histamine-2 receptor antagonist. Lansoprazole and esomeprazole are proton pump inhibitors (PPIs). Metronidazole is an antibiotic.

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? Hematemesis Bradycardia Hypertension Polyuria

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? Hemorrhage Penetration Perforation Pyloric obstruction

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.

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. Liver Pancreas Bladder Duodenum Lungs

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 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? Pelvic x-ray Stool specimen Nasogastric tube insertion Oral contrast

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.

Peptic ulcer disease occurs more frequently in people with which blood type? A B AB O

O Explanation: People with blood type O are more susceptible to peptic ulcers than those with blood type A, B, or AB.

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. Nizatidine Cimetidine Famotidine Omeprazole

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.

Which medication classification represents a proton (gastric acid) pump inhibitor? Omeprazole Sucralfate Famotidine Metronidazole

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.

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? Works best when taken on an empty stomach Increases the speed of gastric emptying Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs) Decreases mucus production

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.

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

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 client is newly diagnosed with stomach cancer. The nurse will plan to provide the client education on which treatment? Surgery Radiation Chemotherapy Intermittent monitoring

Surgery Explanation: Surgery is more hazardous for the older adult, and the risk increases proportionately with increasing age. Nonetheless, gastric cancer should be treated with surgery in older patients. Other treatments such as radiation and chemotherapy will be decided after surgery. Intermittent monitoring is not a treatment option for gastric cancer in the older adult

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? Vasomotor symptoms associated with dumping syndrome Dehiscence of the surgical wound Peritonitis A normal reaction to surgery

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.

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

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 intake of caffeinated beverages. The client asks why this is so important. Which explanation from the nurse would be most accurate? "Caffeine stimulates the central nervous system and thus gastric activity and secretions, which need to be minimized to promote recovery." "Caffeine increases the fluid volume in your system, which irritates your digestive organs." "Caffeine intake can cause tears in your esophagus and intestines, which can lead to hemorrhage." "Caffeine can interfere with absorption of vitamin B12, which leads to anemia and further digestive problems."

"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 is teaching a client about peptic ulcers. The client understands the provided education when stating which of the following? "Hemorrhage and gastritis are the most common complications." "Frequent vomiting is a normal sign of peptic ulcers." "My temperature and blood pressure will remain elevated until the ulcer is healed." "I will take over-the-counter antacids for severe abdominal pain."

"Hemorrhage and gastritis are the most common complications." Explanation: Hemorrhage and gastritis are the most common complications associated with peptic ulcers. Vomiting, elevated temperature, elevated blood pressure, and abdominal pain are symptoms that need further evaluation by the health care provider in clients with a peptic ulcer.

A nurse is performing discharge teaching with a client who had a total gastrectomy. Which statement indicates the need for further teaching? "I'm going to visit my pastor weekly for a while." "I will have to take vitamin B12 shots up to 1 year after surgery." "I will call my physician if I begin to have abdominal pain." "I will weight myself each day and record the weight."

"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 client with an H. pylori infection asks why bismuth subsalicylate is prescribed. Which response will the nurse make? "It improves digestion in the stomach." "It aids in the healing of the stomach lining." "It enhances the function of the pyloric sphincter." "It helps propel food from the stomach into the duodenum."

"It aids in the healing of the stomach lining." Explanation: Bismuth subsalicylate suppresses H. pylori bacteria in the gastric mucosa and assists with healing of mucosal ulcers. It does not affect digestion, enhance the function of the pyloric sphincter, or propel food from the stomach into 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.) "It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." "It is a hereditary disease." "It is probably your nerves."

"It can be caused by ingestion of strong acids." "You may have ingested some irritating foods." "Is it possible that you are overusing aspirin." 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 being treated for a peptic ulcer seeks medical attention for vomiting blood. Which statement indicates to the nurse the reason for the client developing hematemesis? "I think the soda that I drank irritated my stomach." "The pain stopped so I stopped taking the medications." "I felt better but then just got really nauseated and threw up." "I only ate dinner yesterday and it gave me an upset stomach."

"The pain stopped so I stopped taking the medications." Explanation: The client should be instructed to adhere to and complete the medication regimen to ensure complete healing of the peptic ulcer. Because most clients become symptom free within a week, it should be stressed to the client the importance of following the prescribed regimen so that the healing process can continue uninterrupted and the return of symptoms can be prevented. Since the client stopped taking the medication, the ulcer was not healed and became worse. The statements about soda, being nauseated, and eating only one meal would not explain the reason for the client's new onset of hematemesis during treatment for a peptic ulcer.

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? 1.0 L 1.5 L 2.0 L 2.5 L

1.5 L Explanation: 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 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? Acute gastritis Duodenal ulcer Gastric cancer Gastric ulcer

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 with chronic peptic ulcers is considering a vagotomy. Which information will the nurse provide to the client about this surgical procedure? It widens the pylorus to allow increased stomach emptying. It can cause anemia, weight loss, and malabsorption. The lower part of the stomach is attached to the duodenum. Adverse effects such as dumping syndrome and gastritis can occur.

Adverse effects such as dumping syndrome and gastritis can occur. Explanation: A vagotomy is the severing of the vagus nerve to make the cells in the stomach less responsive to gastrin. Adverse effects of this procedure include dumping syndrome and gastritis. A pyloroplasty enlarges the pylorus. The Billroth II procedure can cause anemia, weight loss, and malabsorption. A Billroth I procedure attaches the stomach to the duodenum.

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? Coffee-ground-like Clay-colored Black and tarry Bright red

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 a bleeding gastric ulcer. When examining the client's stool, which characteristic would the nurse be most likely to find? Green color and texture Bright red blood in stool Black and tarry appearance Clay-like quality

Black and tarry appearance Explanation: Black and tarry stools (melena) are a sign of bleeding in the upper gastrointestinal (GI) tract. As the blood moves through the GI system, digestive enzymes turn red blood to black. Bright red blood in the stool is a sign of lower GI bleeding. Green color and texture is a distractor for this question. Clay-like stools are a characteristic of biliary disorders.

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? Discharge planning Correcting nutritional deficits Preventing deep vein thrombosis (DVT) Teaching about radiation treatment

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 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? Curling's ulcer Peptic ulcer Esophageal ulcer Meckel's ulcer

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 with peptic ulcer disease caused by H. pylori is prescribed clarithromycin. Which information will the nurse include when teaching the client about this medication? Do not take this medication with grapefruit juice. Photosensitivity is an adverse effect of this medication. Abdominal pain and diarrhea are expected side effects. Always take this medication on an empty stomach.

Do not take this medication with grapefruit juice. Explanation: Clarithromycin is an antibiotic used to treat H. pylori infection. This medication should not be taken with grapefruit juice. Photosensitivity is an adverse effect of tetracycline. Amoxicillin can cause abdominal pain and diarrhea. Metronidazole can be taken with meals to decrease GI upset.

The nurse is caring for a client who has undergone a total gastrectomy. Several hours after surgery, the nurse notes that the client's nasogastric (NG) tube has minimal drainage. How should the nurse respond? Document the findings. Reposition the tube. Irrigate the tube. Increase the suction level.

Document the findings. Explanation: Normally, the amount of NG drainage after a total gastrectomy is minimal as there is no reservoir where secretions can collect. 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 the GI mucosa or the suture line.

The nurse is caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client? Drink a minimum of 12 ounces of fluid with each meal. Eat several small meals daily spaced at equal intervals. Choose foods that are high in simple carbohydrates. Sit upright when eating and for 30 minutes afterward.

Eat several small meals daily spaced at equal intervals. Explanation: The client with dumping syndrome should consume small meals at intervals to reduce symptoms. The client should not consume fluids with meals. Carbohydrates should be limited and sitting upright does not relieve the symptoms.

A client has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the client should adopt what dietary guidelines? Eat small, frequent meals with high calorie and vitamin content. Eat frequent meals with an equal balance of fat, carbohydrates, and protein. Eat frequent, low-fat meals with high protein content. Try to maintain the pre-diagnosis pattern of eating.

Eat small, frequent meals with high calorie and vitamin content. Explanation: The nurse encourages the client to eat small, frequent portions of nonirritating foods to decrease gastric irritation. Food supplements should be high in calories, as well as vitamins A and C and iron, to enhance tissue repair.

A health care provider suspects that a client has peptic ulcer disease. With which diagnostic procedure would the nurse most likely prepare to assist? Barium study of the upper gastrointestinal tract Endoscopy Gastric secretion study Stool antigen test

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.

During assessment of a patient with gastritis, the nurse practitioner attempts to distinguish acute from chronic pathology. One criteria, characteristic of gastritis would be the: Immediacy of the occurrence. Presence of vomiting. Frequency of abdominal discomfort. Incidence of anorexia.

Immediacy of the occurrence. Explanation: Acute gastritis usually develops quickly, whereas chronic gastritis results from prolonged inflammation of the stomach.

A client diagnosed with a peptic ulcer says, "Now I have something else I have to worry about." Which actions will the nurse take to help reduce the client's anxiety? Select all that apply. Interact with the client in a relaxed manner. Help identify the client's current stressors. Discuss potential coping techniques with the client. Offer information about relaxation methods. Inform the client the medication will solve the problem.

Interact with the client in a relaxed manner. Help identify the client's current stressors. Discuss potential coping techniques with the client. Offer information about relaxation methods. A client with a peptic ulcer may have a problem with anxiety. To help reduce the client's anxiety, the nurse should interact with the client in a relaxed manner and help the client identify stressors. The nurse can also discuss potential coping techniques and offer information about relaxation methods. Stating that medication will solve the problem may not be sufficient if stress and anxiety are contributors to the development of the ulcer.

Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? Mental confusion Bradycardia Bradypnea Hypertension

Mental confusion Explanation: Signs of bleeding include tachycardia, tachypnea, hypotension, mental confusion, thirst, and oliguria.

Which is a true statement regarding gastric cancer? Most clients are asymptomatic during the early stage of the disease. Women have a higher incidence of gastric cancer. The prognosis for gastric cancer is good. Most cases are discovered before metastasis.

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.

During a home visit the nurse notes that a client recovering from peptic ulcer disease is experiencing cool clammy skin and has a heart rate of 96 beats a minute. Which action will the nurse take? Notify the primary health care provider. Provide a dose of a proton pump inhibitor. Encourage the client to drink a warm beverage. Discuss the types of foods the client has been eating.

Notify the primary health care provider. Explanation: The client with peptic ulcer disease is demonstrating signs of hemorrhage which include cool skin and tachycardia. The health care provider should be immediately notified. The client should not be given any additional medication. A warm beverage could enhance bleeding. It is inappropriate to provide any teaching while the client is experiencing an acute condition.

A client is in the hospital for the treatment of peptic ulcer disease. The client reports vomiting and a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate? Ineffective treatment for the peptic ulcer A reaction to the medication given for the ulcer Gastric penetration Perforation of the peptic ulcer

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

The nurse advises the patient who has just been diagnosed with acute gastritis to: Take an emetic to rid the stomach of the irritating products. Refrain from food until the GI symptoms subside. Restrict food and fluids for 12 hours. Restrict all food for 72 hours to rest the stomach.

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.

The nurse is caring for a client with chronic gastritis. Which interventions will the nurse add to this client's plan of care? Select all that apply. Remind to avoid alcohol intake. Review actions to reduce stress. Provide omeprazole as prescribed. Instruct to avoid foods that aggravate the condition. Suggest using over the counter ibuprofen for pain control.

Remind to avoid alcohol intake. Review actions to reduce stress. Provide omeprazole as prescribed. Instruct to avoid foods that aggravate the condition. Explanation: Chronic gastritis is managed by recommending avoidance of alcohol, reducing stress, providing medications to include proton pump inhibitors, and modifying the diet by avoiding foods that aggravate the condition. Over-the-counter NSAIDs should be avoided as this can aggravate the condition.

Which of the following is the most successful treatment for gastric cancer? Removal of the tumor Chemotherapy Radiation Palliation

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 client recovering from surgery to resect a gastric tumor reports abdominal cramping and diarrhea after eating. Which additional symptoms will the nurse use to determine if the client is experiencing dumping syndrome? Select all that apply. Inability to tolerate foods with animal fat Report of extreme hunger 3 hours after eating Sudden onset of extreme shakiness and fatigue Audible bowel sounds and pain radiating to the back Increased desire to consume foods that are dairy products

Report of extreme hunger 3 hours after eating Sudden onset of extreme shakiness and fatigue Explanation: Dumping syndrome may occur as a result of any surgical procedure that involves the removal of a significant portion of the stomach. Early symptoms tend to occur within 10 to 30 minutes after a meal and often include early satiety, cramping abdominal pain, nausea, vomiting, and diarrhea. Later, the rapid elevation in blood glucose is followed by the increased secretion of insulin, which results in hypoglycemia 2 to 3 hours after eating. Manifestations of hypoglycemia may include extreme hunger, shakiness, and fatigue. Findings associated with dumping syndrome do not include an intolerance of foods with animal fat, audible bowel sounds with pain radiating to the back, or a desire to consume dairy products.

A client with peptic ulcer disease has been prescribed sucralfate. What health education should the nurse provide to this client? Take the medication 2 hours before or after other medications Blood levels will be evaluated after 1 week Take the medication at bedtime to accommodate sedative effects Ensure adequate potassium intake during therapy

Take the medication 2 hours before or after other medications Explanation: Sucralfate should be taken at least 2 hours before or after other medications. It does not decrease potassium levels and laboratory follow up is unnecessary. Sucralfate does not cause sedation.

The nurse is preparing a teaching tool about delayed release proton pump inhibitors used to treat duodenal ulcer disease caused by H. pylori. Which statement will the nurse include that would apply to most types of proton pump inhibitor prescribed to treat this condition? May cause diarrhea and hyperglycemia Interferes with the metabolism of digoxin, iron, and warfarin Abdominal pain and abnormal liver function tests are expected effects The medication is to be swallowed whole and taken before meals

The medication is to be swallowed whole and taken before meals Explanation: There are several proton pump inhibitors used to treat duodenal ulcers caused by H. pylori. For most of these medications, they are a delayed-release capsule that is to be swallowed whole and taken before meals. Pantoprazole may cause diarrhea and hyperglycemia. Rabeprazole is the only proton pump inhibitor that interferes with the metabolism of digoxin, iron, and warfarin. Rabeprazole may cause abdominal pain. Pantoprazole may cause abnormal liver function tests.

Which statement correctly identifies a difference between duodenal and gastric ulcers? Malignancy is associated with duodenal ulcer. Weight gain may occur with a gastric ulcer. A gastric ulcer is caused by hypersecretion of stomach acid. Vomiting is uncommon in clients with duodenal ulcers.

Vomiting is uncommon in clients with duodenal ulcers. Explanation: Vomiting is uncommon in clients diagnosed with duodenal ulcer. Malignancy is associated with a gastric ulcer. Weight gain may occur with a duodenal ulcer. Duodenal ulcers cause hypersecretion of stomach acid.

The nurse recognizes that the client diagnosed with a duodenal ulcer will likely experience vomiting. hemorrhage. pain 2 to 3 hours after a meal. weight loss.

pain 2 to 3 hours after a meal. Explanation: The client with a duodenal 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 in the client with gastric ulcer. The client with a duodenal ulcer may experience weight gain.