Brunner's Ch 46: Management of Patients with Gastric and Duodenal Disorders Flashcards
A nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When teaching the patient about his new diagnosis, how should the nurse best describe a peptic ulcer?
A) Inflammation of the lining of the stomach
B) Erosion of the lining of the stomach or intestine
C) Bleeding from the mucosa in the stomach
D) Viral invasion of the stomach wall
B) Erosion of the lining of the stomach or intestine
A peptic ulcer is erosion of the lining of the stomach or intestine. Peptic ulcers are often accompanied by bleeding and inflammation, but these are not the definitive characteristics.
A patient comes to the clinic complaining of pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the patient has a peptic ulcer?
A) Does your pain resolve when you have something to eat?
B) Do over-the-counter pain medications help your pain?
C) Does your pain get worse if you get up and do some exercise?
D) Do you find that your pain is worse when you need to have a bowel movement?
A) Does your pain resolve when you have something to eat?
Pain relief after eating is associated with duodenal ulcers. The pain of peptic ulcers is generally unrelated to activity or bowel function and may or may not respond to analgesics.
A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole (Prilosec). How should the nurse best describe this medications therapeutic action?
A) This medication will reduce the amount of acid secreted in your stomach.
B) This medication will make the lining of your stomach more resistant to damage.
C) This medication will specifically address the pain that accompanies peptic ulcer disease.
D) This medication will help your stomach lining to repair itself.
A) This medication will reduce the amount of acid secreted in your stomach.
Proton pump inhibitors like Prilosec inhibit the synthesis of stomach acid. PPIs do not increase the durability of the stomach lining, relieve pain, or stimulate tissue repair.
A nurse is admitting a patient diagnosed with late-stage gastric cancer. The patients family is distraught and angry that she was not diagnosed earlier in the course of her disease. What factor contributes to the fact that gastric cancer is often detected at a later stage?
a. Gastric cancer does not cause signs or symptoms until metastasis has occurred.
b. Adherence to screening recommendations for gastric cancer is exceptionally low.
c. Early symptoms of gastric cancer are usually attributed to constipation.
d. The early symptoms of gastric cancer are usually not alarming or highly unusual.
d. The early symptoms of gastric cancer are usually not alarming or highly unusual.
Symptoms of early gastric cancer, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms are rarely a cause for alarm or for detailed diagnostic testing. Symptoms precede metastasis, however, and do not include constipation.
A nurse is preparing to discharge a patient after recovery from gastric surgery. What is an appropriate discharge outcome for this patient?
a. The patients bowel movements maintain a loose consistency.
b. The patient is able to tolerate three large meals a day.
c. The patient maintains or gains weight.
d. The patient consumes a diet high in calcium.
c. The patient maintains or gains weight.
Expected outcomes for the patient following gastric surgery include ensuring that the patient is maintaining or gaining weight (patient should be weighed daily), experiencing no excessive diarrhea, and tolerating six small meals a day. Patients may require vitamin B12 supplementation by the intramuscular route and do not require a diet excessively rich in calcium.
A nurse caring for a patient who has had bariatric surgery is developing a teaching plan in anticipation of the patients discharge. Which of the following is essential to include?
A) Drink a minimum of 12 ounces of fluid with each meal.
B) Eat several small meals daily spaced at equal intervals.
C) Choose foods that are high in simple carbohydrates.
D) Sit upright when eating and for 30 minutes afterward.
B) Eat several small meals daily spaced at equal intervals.
Due to decreased stomach capacity, the patient must consume small meals at intervals to meet nutritional requirements while avoiding a feeling of fullness and complications such as dumping syndrome. The patient should not consume fluids with meals and low-Fowlers positioning is recommended during and after meals. Carbohydrates should be limited.
A nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the patients health problem?
A) Consumes one or more protein drinks daily.
B) Takes over-the-counter antacids frequently throughout the day.
C) Smokes one pack of cigarettes daily.
D) Reports a history of social drinking on a weekly basis.
C) Smokes one pack of cigarettes daily.
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 patients with a history of consumption of alcohol on a daily basis.
A nurse in the postanesthesia care unit admits a patient following resection of a gastric tumor. Following immediate recovery, the patient should be placed in which position to facilitate patient comfort and gastric emptying? A) Fowlers B) Supine C) Left lateral D) Left Sims
A) Fowlers
Positioning the patient in a Fowlers position postoperatively promotes comfort and facilitates emptying of the stomach following gastric surgery. Any position that involves lying down delays stomach emptying and is not recommended for this type of patient. Supine positioning and the left lateral (left Sims) position do not achieve this goal.
A community health nurse is preparing for an initial home visit to a patient discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include?
A) Enteral feeding via gastrostomy tube (G tube)
B) Gastrointestinal decompression by nasogastric tube
C) Periodic assessment for esophageal distension
D) Monthly administration of injections of vitamin B12
D) Monthly administration of injections of vitamin B12
Since vitamin B12 is absorbed in the stomach, the patient requires vitamin B12 replacement to prevent pernicious anemia. A gastrectomy precludes the use of a G tube. Since the stomach is absent, a
nasogastric tube would not be indicated. As well, this is not possible in the home setting. Since there is no stomach to act as a reservoir and fluids and nutrients are passing directly into the jejunum, distension is unlikely.
A nurse is assessing a patient who has peptic ulcer disease. The patient requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the patient?
A) Most affected patients acquired the infection during international travel.
B) Infection typically occurs due to ingestion of contaminated food and water.
C) Many people possess genetic factors causing a predisposition to H. pylori infection.
D) The H. pylori microorganism is endemic in warm, moist climates.
B) Infection typically occurs due to ingestion of contaminated food and water.
Most peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water. The organism is endemic to all areas of the United States. Genetic factors have not been identified.
A patient who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the patients condition is now stable. For the next several hours, the nurse caring for this patient should assess for what signs and symptoms of recurrence?
A) Tachycardia, hypotension, and tachypnea
B) Tarry, foul-smelling stools
C) Diaphoresis and sudden onset of abdominal pain
D) Sudden thirst, unrelieved by oral fluid administration
A) Tachycardia, hypotension, and tachypnea
Tachycardia, hypotension, and tachypnea are signs of recurrent bleeding. Patients who have had one GI bleed are at risk for recurrence. Tarry stools are expected short-term findings after a hemorrhage. Hemorrhage is not normally associated with sudden thirst or diaphoresis.
A patient presents to the walk-in clinic complaining of vomiting and burning in her mid-epigastria. The nurse knows that in the process of confirming peptic ulcer disease, the physician is likely to order a diagnostic test to detect the presence of what? A) Infection with Helicobacter pylori B) Excessive stomach acid secretion C) An incompetent pyloric sphincter D) A metabolic acidbase imbalance
A) Infection with Helicobacter pylori
H. pylori infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen. Excessive stomach acid secretion leads to gastritis; however, peptic ulcers are caused by colonization of the stomach by H. pylori. Sphincter dysfunction and acidbase imbalances do not cause peptic ulcer disease.
A patient with a peptic ulcer disease has had metronidazole (Flagyl) added to his current medication regimen. What health education related to this medication should the nurse provide?
a. Take the medication on an empty stomach.
b. Take up to one extra dose per day if stomach pain persists.
c. Take at bedtime to mitigate the effects of drowsiness.
d. Avoid drinking alcohol while taking the drug.
d. Avoid drinking alcohol while taking the drug.
Alcohol must be avoided when taking Flagyl and the medication should be taken with food. This drug does not cause drowsiness and the dose should not be adjusted by the patient.
A patient was treated in the emergency department and critical care unit after ingesting bleach. What possible complication of the resulting gastritis should the nurse recognize?
a. Esophageal or pyloric obstruction related to scarring
b. Uncontrolled proliferation of H. pylori
c. Gastric hyperacidity related to excessive gastrin secretion
d. Chronic referred pain in the lower abdomen
a. Esophageal or pyloric obstruction related to scarring
A 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. Scarring can occur, resulting in pyloric stenosis (narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom of peptic ulcer disease, but would not be an expected finding for a patient who has ingested a corrosive substance. Bacterial proliferation and hyperacidity would not occur.
A patient who underwent gastric banding 3 days ago is having her diet progressed on a daily basis. Following her latest meal, the patient complains of dizziness and palpitations. Inspection reveals that the patient is diaphoretic. What is the nurses best action?
A) Insert a nasogastric tube promptly.
B) Reposition the patient supine.
C) Monitor the patient closely for further signs of dumping syndrome.
D) Assess the patient for signs and symptoms of aspiration.
C) Monitor the patient closely for further signs of dumping syndrome.
The patients symptoms are characteristic of dumping syndrome, which results in a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. Aspiration is a less likely cause for the patients symptoms. Supine positioning will likely exacerbate the symptoms and insertion of an NG tube is contraindicated due to the nature of the patients surgery.
A patient is one month postoperative following restrictive bariatric surgery. The patient tells the clinic nurse that he has been having trouble swallowing for the past few days. What recommendation should the nurse make?
A) Eating more slowly and chewing food more thoroughly
B) Taking an OTC antacid or drinking a glass of milk prior to each meal
C) Chewing gum to cause relaxation of the lower esophageal sphincter
D) Drinking at least 12 ounces of liquid with each meal
A) Eating more slowly and chewing food more thoroughly
Dysphagia may be prevented by educating patients to eat slowly, to chew food thoroughly, and to avoid eating tough foods such as steak or dry chicken or doughy bread. After bariatric procedures, patients should normally not drink beverages with meals. Medications or chewing gum will not alleviate this problem.
