Chapter 47 Management of Patients with Gastric and Duodenal Disorders

A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client’s stools to be:
black and tarry.

A nurse is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention:
alcohol abuse and smoking.

A client is admitted to the hospital with an exacerbation of his chronic gastritis. When assessing his nutritional status, the nurse should expect a deficiency in:
vitamin B12.

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

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?
Agitation

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?
Prevents ulceration in clients taking nonsteroidal anti-inflammatory drugs (NSAIDs)

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, and labored breathing; the client also appears to be confused. Which of the following complications has the client most likely developed?
Hemorrhage

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

The nurse is conducting a community education class on gastritis. The nurse includes that chronic gastritis caused by Helicobacter pylori is implicated in which disease/condition?
Peptic ulcers

A patient taking metronidazole (Flagyl) for the treatment of H. pylori states that the medication is causing nausea. What suggestion can the nurse provide to the patient to alleviate this problem?
Take the medication with meals to decrease the nausea.

A nurse is caring for a client who is undergoing a diagnostic workup for a suspected GI problem. The client reports gnawing epigastric pain following meals and heartburn. The nurse suspects the client has:
peptic ulcer disease.

Which is a true statement regarding gastric cancer?
Most clients are asymptomatic during the early stage of the disease.

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

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply.
– Severe peptic ulcers
– Extreme gastric hyperacidity
– Gastrin-secreting tumors of the pancreas

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.
IBW = 145 lbs; weight = 290 lbs; BMI = 31 kg/m2

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. The nurse suspects:
Vasomotor symptoms associated with dumping syndrome

A client is prescribed tetracycline to treat peptic ulcer disease. Which of the following instructions would the nurse give the client?
“Be sure to wear sunscreen while taking this medicine.”

A nurse is assessing a client who is interested in undergoing bariatric surgery. Which of the following are criteria for candidacy? Select all that apply.
– No history of psychiatric illness
– Understanding of required lifestyle changes

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 of the following explanations 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.”

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

A client with a peptic ulcer is about to begin a therapeutic regimen that includes a bland diet, antacids, and famotidine (Pepcid). Before the client is discharged, the nurse should provide which instruction?
“Avoid aspirin and products that contain aspirin.”

Why are antacids administered regularly, rather than as needed, in peptic ulcer disease?
To keep gastric pH at 3.0 to 3.5

A client has recently been diagnosed with gastric cancer. He 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 this diagnosis because he has been asymptomatic prior to recent complaints of pain and multiple gastrointestinal symptoms. On palpation, the nurse notes two signs that confirm metastasis to the liver. Which of the following are signs? Choose all that apply.
– Ascites
– Hepatomegaly

Which of the following are signs/symptoms of perforation?
Sudden, severe upper abdominal pain

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

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

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.
Amount of hydrochloric acid (HCL) secretion in the stomach

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.
– Ingestion of strong acids
– Irritating foods
– Overuse of aspirin

A patient is scheduled for removal of the lower portion of the antrum of the stomach and a small portion of the duodenum and pylorus. What is the name of this surgical procedure for peptic ulcer disease?
Billroth I

Symptoms associated with pyloric obstruction include all of the following except:
Diarrhea

The nurse is teaching a client about preventing dysphagia after bariatric surgery. The nurse tells the client to avoid which foods? Select all that apply.
– Doughy bread
– Steak

A client reports to the clinic, stating that she rapidly developed headache, abdominal pain, nausea, hiccuping, and fatigue about 2 hours ago. For dinner, she ate buffalo chicken wings and beer. Which of the following medical conditions is most consistent with the client’s presenting problems?
Acute gastritis

A patient 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 patient complained of cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the patient be educated about regarding this event?
Dumping syndrome

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?
Nothing by mouth

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

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 to his right shoulder. The intial appropriate action by the nurse is to
Assess the client’s abdomen and vital signs.

Morbid obesity is defined as being how many pounds over the person’s ideal body weight?
100

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to:
drink liquids only between meals.

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.”

A client weighs 215 lbs and is 5′ 8″ tall. The nurse would calculate this client’s body mass index (BMI) as which of the following?
32.7

A nursing student notes that a client has a new physician order for a proton-pump inhibitor. The student knows that a frequently prescribed proton-pump inhibitor of gastric acid is
Nexium

Which of the following appears to be a significant factor in the development of gastric cancer?
Diet

A patient is in the hospital for the treatment of peptic ulcer disease. The nurse finds the patient vomiting and complaining of a sudden severe pain in the abdomen. The nurse then assesses a board-like abdomen. What does the nurse suspect these symptoms indicate?
Perforation of the peptic ulcer

A patient comes to the clinic complaining of pain in the epigastric region. The nurse suspects that the patient’s pain is related to a peptic ulcer when the patient states the pain is relieved by what?
Eating

The nurse in the ED is admitting a client with bloody stools. The nurse documents this finding as
hematochezia.

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

A physician suspects that a client has peptic ulcer disease. With which of the following diagnostic procedures would the nurse most likely prepare to assist?
Endoscopy

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.

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.

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

Clients with Type O blood are at higher risk for which of the following GI disorders?
Duodenal ulcers

A patient has a BMI ranger greater than 40 kg/m2. What would this patient’s obesity classification be?
Class III

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.
Omeprazole (Prilosec)

A nurse is caring for a client who underwent a subtotal gastrectomy 24 hours ago. The client has a nasogastric (NG) tube. The nurse should:
irrigate the NG tube gently with normal saline solution if ordered.

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?
Nasogastric tube insertion

The nurse is aware that hemorrhage is a common complication of peptic ulcer disease. Therefore, assessment for indicators of bleeding is an important nursing responsibility. Which of the following are indicators of bleeding? Select all that apply.
– Melena
– Tachypnea
– Thirst
– Mental confusion

The nurse is caring for a client who underwent a subtotal gastrectomy 36 hours ago. The client has a nasogastric (NG) tube. The nurse knows to do the following with the NG:
Irrigate the NG tube gently with normal saline if ordered.

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?
“The medications will kill the bacteria and stop the acid production.”

Which of the following is included as a dietary guideline for a patient who has had bariatric surgery?
Restrict total meal size to less than 1 cup.

A patient 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 patient?
Curling’s ulcer

A client admitted for treatment of a gastric ulcer is being prepared for discharge on antacid therapy. Discharge teaching should include which instruction?
“Continue to take antacids even if your symptoms subside.”

Which ulcer is associated with extensive burn injury?
Curling ulcer

The nurse receives report on 4 clients. Which client should the nurse see first? 1. Client admitted 12 hours ago with acute asthma exacerbation who needs a dose of IV methylprednisolone [21%] 2. Client admitted 2 days ago with congestive …

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? Glucose level After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion …

A nurse is counseling the spouse of a client who has a history of alcohol abuse. What does the nurse explain is the main reason for drinking alcohol in people with a long history of alcohol abuse? 1 They are …

1. When formulating a definition of “health,” the nurse should consider that health, within its current definition, is: 1. The absence of disease 2. A function of the physiological state 3. The ability to pursue activities of daily living 4. …

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