Chapter_46_Med_Surg

MED-SURG Chapter 46: Management of Patients With Gastric and Duodenal Disorders Question 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. Question Which of the following is the most successful treatment for gastric cancer? • Removal of the tumor Question A nurse is teaching a client who has experienced an episode of acute gastritis and knows further education is necessary when the client makes the following statement: • “My appetite should come back tomorrow.” Question 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 Question A client experienced extensive burns and 72 hours later has developed an ulcer. Which of the following types of ulcer is most likely in this client? • Curling's ulcer Question 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. The nurse suspects the client has: • dumping syndrome. Question 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 Question 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.” Question 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 Question Peptic ulcer disease occurs more frequently in people with which blood type? • O Question 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. Question 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 Question 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 Question The nurse determines that teaching for the client with peptic ulcer disease has been effective when the client states: • "I have learned some relaxation strategies that decrease my stress." Question 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. Question 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." Question A client with gastric cancer is scheduled to undergo a Billroth II procedure. The client’s spouse asks how much of the client’s stomach will be removed. Which of the following would be the most accurate response from the nurse? • Approximately 75% Question Which of the following medications used for obesity improves cardiovascular disease risk factors in obese patients with metabolic syndrome? • Rimonabant (Acomplia) Question Which of the following appears to be a significant factor in the development of gastric cancer? • Diet Question 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 Question Which medication classification represents a proton (gastric acid) pump inhibitor? • Omeprazole Question Which diagnostic test would be used first to evaluate a client with upper GI bleeding? • Hemoglobin and hematocrit Question 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 Question Symptoms associated with pyloric obstruction include all of the following except: • Diarrhea Question 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 Question 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 Question 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.” Question 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 order? • Bismuth salts, antibiotics, and proton pump inhibitors Question 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 Question The nurse reviews dietary guidelines with a patient who had a gastric banding. Which of the following teaching points are included? Select all that apply. • 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. Question 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. The nurse suspects the client has: • dumping syndrome. Question 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 Question 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 • Duodenum Question 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 • 15% Question 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: • Hemorrhage Question Which of the following is the most successful treatment for gastric cancer? • Removal of the tumor Question 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? • Awakening in pain Question 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 Question 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 Question 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 Question Which statement correctly identifies a difference between duodenal and gastric ulcers? • Vomiting is uncommon in clients with duodenal ulcers. Question Clients with Type O blood are at higher risk for which of the following GI disorders? • Duodenal ulcers Question 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 Question 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 Question 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 Question 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? • 1.5 L Question 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. Question 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. Question A patient is complaining of diarrhea after having bariatric surgery. What nonpharmacologic treatment can the nurse suggest to decrease the incidence of diarrhea? • Decrease the fat content in the diet. Question A nurse caring for a patient in a burn treatment center knows to assess for the presence of which of the following types of ulcer about 72 hours post injury? • Curling's Question 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. Question 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. Question The nurse is caring for a client with chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? • Vitamin B12 Question 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." Question Which of the following appears to be a significant factor in the development of gastric cancer? • Diet Question A nurse is monitoring a client with peptic ulcer disease. Which of the following assessment findings would most likely indicate perforation of the ulcer? Choose all that apply. • Tachycardia • Hypotension • A rigid, board-like abdomen Question 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 Question 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.” Question The nurse advises the patient who has just been diagnosed with acute gastritis to: • Refrain from food until the GI symptoms subside. Question 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) Question 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 Question A client returns from the operating room after receiving extensive abdominal surgery. He has 1,000 mL of lactated Ringer's solution infusing via a central line. The physician orders the IV fluid to be infused at 125 mL/hr plus the total output of the previous hour. The drip factor of the tubing is 15 gtt/min, and the output for the previous hour was 75 mL via Foley catheter, 50 mL via nasogastric tube, and 10 mL via Jackson Pratt tube. For how many drops per mintue should the nurse set the IV flow rate to deliver the correct amount of fluid? Enter the correct number ONLY. • 65 Question Which diagnostic test would be used first to evaluate a client with upper GI bleeding? • Hemoglobin and hematocrit Question A client with a peptic ulcer is diagnosed with Helicobacter 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." Question 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. • Computed tomography (CT) • Endoscopic ultrasound Question A client with gastric cancer is scheduled to undergo a Billroth II procedure. The client’s spouse asks how much of the client’s stomach will be removed. Which of the following would be the most accurate response from the nurse? • Approximately 75% Question 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 Question Symptoms associated with pyloric obstruction include all of the following except: • Diarrhea Question Which of the following are signs/symptoms of perforation? • Sudden, severe upper abdominal pain Question Which medication taken by clients with obesity improves cardiovascular disease risk factors in obese clients with metabolic syndrome? • Rimonabant Question Which medication is classified as a histamine-2 receptor antagonist? • Famotidine Question Peptic ulcer disease occurs more frequently in people with which blood type? • O Question Clients with Type O blood are at higher risk for which of the following GI disorders? • Duodenal ulcers Question 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 Question Rebleeding may occur from a peptic ulcer and often warrants surgical interventions. Signs of bleeding include which of the following? • Mental confusion Question 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 Question 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. Question 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 Question A patient being treated for pyloric obstruction has a nasogastric (NG) tube in place to decompress the stomach. The nurse routinely checks for a residual amount that would indicate obstruction. Choose that amount. • 450 mL Question Which ulcer is associated with extensive burn injury? Curling ulcer