Hinkle 40

Question 1

A nurse is caring for a client who just has been diagnosed with a peptic ulcer. When
teaching the client about his new diagnosis, how should the nurse best describe it?
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

Answer 1

ANS: B
Rationale: 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.

Question 2

A nurse is admitting a client diagnosed with late-stage gastric cancer. The client’s
family is distraught and angry that the client was not diagnosed earlier in the course of
her disease. What factor most likely contributed to the client’s late diagnosis?
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.

Answer 2

Ans: D
Rationale: 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.

Question 3

A nurse is preparing to discharge a client after recovery from gastric surgery. What is
an appropriate discharge outcome for this client?
A. Bowel movements maintain a loose consistency.
B. Three large meals per day are tolerated.
C. Weight is maintained or gained.
D. High calcium diet is consumed.

Answer 3

ANS: C
Rationale: Weight loss is common in the postoperative period, with early satiety,
dysphagia, reflux and regurgitation, and elimination issues contributing to this problem.
The client should weigh oneself daily, with a goal of maintaining or gaining weight. The
client should not have bowel movements that maintain a loose consistency, because this
would indicate diarrhea and would warrant intervention as it is a symptom of dumping
syndrome. The client should be able to tolerate six small meals per day, rather than three
large meals. The client does not require a diet excessively rich in calcium but should
consume a diet high in calories, iron, vitamin A and vitamin C.

Question 4

A nurse is completing a health history on a client whose diagnosis is chronic gastritis.
Which of the data should the nurse consider most significantly related to the etiology of
the client’s 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.

Answer 4

ANS: C
Rationale: 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 clients with a history of consumption of alcohol on a daily basis.

Question 5

A community health nurse is preparing for an initial home visit to a client 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. Administration of injections of vitamin B12

Answer 5

ANS: D
Rationale: Since vitamin B12 is absorbed in the stomach, the client 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.

Question 6

A nurse is assessing a client who has peptic ulcer disease. The client requests more
information about the typical causes of Helicobacter pylori infection. What would it be
appropriate for the nurse to instruct the client?
A. Most affected clients 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.

Answer 6

ANS: B
Rationale: 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 many areas, not only warm, moist climates. Genetic factors have not been
identified.

Question 7

A client who experienced a large upper gastrointestinal (GI) bleed due to gastritis has
had the bleeding controlled and is now stable. For the next several hours, the nurse
caring for this client 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

Answer 7

ANS: A
Rationale: Tachycardia, hypotension, and tachypnea are signs of recurrent bleeding.
Clients 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.

Question 8

A client presents to the clinic reporting vomiting and burning in the mid-epigastria. The
nurse knows that in the process of confirming peptic ulcer disease, the health care
provider 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 acid–base imbalance

Answer 8

ANS: A
Rationale: 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 acid–base
imbalances do not cause peptic ulcer disease.

Question 9

A client with a peptic ulcer disease has had metronidazole added to their 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.

Answer 9

ANS: D
Rationale: Alcohol must be avoided when taking metronidazole and the medication
should be taken with food. This drug does not cause drowsiness and the dose should not
be adjusted by the client.

Question 10

A client 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

Answer 10

ANS: A
Rationale: 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 client who has ingested a corrosive substance. Bacterial
proliferation and hyperacidity would not occur.

Question 11

A client who underwent a gastric resection 3 weeks ago is having their diet
progressed on a daily basis. Following the latest meal, the client reports dizziness and
palpitations. Inspection reveals that the client is diaphoretic. What is the nurse’s best
action?
A. Insert a nasogastric tube promptly.
B. Reposition the client supine.
C. Monitor the client closely for further signs of dumping syndrome.
D. Assess the client for signs and symptoms of aspiration.

Answer 11

ANS: C
Rationale: The client’s 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 client’s symptoms.
Supine positioning will likely exacerbate the symptoms and insertion of an NG tube is
contraindicated due to the nature of the client’s surgery.

Question 12

A client is receiving education about an upcoming Billroth I procedure
(gastroduodenostomy). This client should be informed that the client may experience
which of the following adverse effects associated with this procedure?
A. Persistent feelings of hunger and thirst
B. Constipation or bowel incontinence
C. Diarrhea and feelings of fullness
D. Gastric reflux and belching

Answer 12

ANS: C
Rationale: Following a Billroth I, the client may have problems with feelings of fullness,
dumping syndrome, and diarrhea. Hunger and thirst, constipation, and gastric reflux are
not adverse effects associated with this procedure.

Question 13

A nurse is providing client education for a client with peptic ulcer disease secondary
to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The client has recently been
prescribed misoprostol. What would the nurse be most accurate in informing the client
about the drug?
A. It reduces the stomach’s volume of hydrochloric acid
B. It increases the speed of gastric emptying
C. It protects the stomach’s lining
D. It increases lower esophageal sphincter pressure

Answer 13

ANS: C
Rationale: Misoprostol is a synthetic prostaglandin that, like prostaglandin, protects the
gastric mucosa. NSAIDs decrease prostaglandin production and predispose the client to
peptic ulceration. Misoprostol does not reduce gastric acidity, improve emptying of the
stomach, or increase lower esophageal sphincter pressure.

Question 14

A nurse is providing anticipatory guidance to a client who is preparing for a total
gastrectomy. The nurse learns that the client is anxious about numerous aspects of the
surgery. What intervention is most appropriate to alleviate the client’s anxiety?
A. Emphasize the fact that gastric surgery has a low risk of complications.
B. Encourage the client to focus on the benefits of the surgery.
C. Facilitate the client’s contact with support services.
D. Obtain an order for a PRN benzodiazepine.

Answer 14

ANS: C
Rationale: The services of clergy, psychiatric clinical nurse specialists, psychologists,
social workers, and psychiatrists are made available, and can reduce the client’s anxiety.
This is preferable to antianxiety medications. Downplaying the risks of surgery or
focusing solely on the benefits is a simplistic and patronizing approach.

Question 15

A client has just been diagnosed with acute gastritis after presenting in distress to the
emergency department with abdominal symptoms. What would be the nursing care
most needed by the client at this time?
A. Teaching the client about necessary nutritional modification
B. Helping the client weigh treatment options
C. Teaching the client about the etiology of gastritis
D. Providing the client with physical and emotional support

Answer 15

ANS: D
Rationale: For acute gastritis, the nurse provides physical and emotional support and
helps the client manage the symptoms, which may include nausea, vomiting, heartburn,
and fatigue. The scenario describes a newly diagnosed client; teaching about the etiology
of the disease, lifestyle modifications, or various treatment options would be best
provided at a later time.

Question 16

A client is recovering in the hospital following gastrectomy. The nurse notes that the
client has become increasingly difficult to engage and has had several angry outbursts at
staff members in recent days. The nurse’s attempts at therapeutic dialogue have been
rebuffed. What is the nurse’s most appropriate action?
A. Ask the client’s primary provider to liaise between the nurse and the client.
B. Delegate care of the client to a colleague.
C. Limit contact with the client in order to provide privacy.
D. Make appropriate referrals to services that provide psychosocial support.

Answer 16

ANS: D
Rationale: The nurse should enlist the services of clergy, psychiatric clinical nurse
specialists, psychologists, social workers, and psychiatrists, if needed. This is preferable
to delegating care, since the client has become angry with other care providers as well. It
is impractical and inappropriate to expect the primary provider to act as a liaison. It
would be inappropriate and unsafe to simply limit contact with the client.

Question 17

A client has been admitted to the hospital after diagnostic imaging revealed the
presence of a gastric outlet obstruction (GOO). What is the nurse’s priority intervention?
A. Administration of antiemetics
B. Insertion of an NG tube for decompression
C. Infusion of hypotonic IV solution
D. Administration of proton pump inhibitors as prescribed

Answer 17

ANS: B
Rationale: In treating the client with gastric outlet obstruction, the first consideration is
to insert an NG tube to decompress the stomach. This is a priority over fluid or medication
administration.

Question 18

Diagnostic imaging and physical assessment have revealed that a client with peptic
ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency
interventions must be performed as soon as possible in order to prevent the development
of what complication?
A. Peritonitis
B. Gastritis
C. Gastroesophageal reflux
D. Acute pancreatitis

Answer 18

ANS: A
Rationale: Perforation is the erosion of the ulcer through the gastric serosa into the
peritoneal cavity without warning. Chemical peritonitis develops within a few hours of
perforation and is followed by bacterial peritonitis. Gastritis, reflux, and pancreatitis are
not acute complications of a perforated ulcer

Question 19

A client has been prescribed cimetidine for the treatment of peptic ulcer disease.
When providing relevant health education for this client, the nurse should ensure the
client is aware of what potential outcome?
A. Bowel incontinence
B. Drug-drug interactions
C. Abdominal pain
D. Heat intolerance

Answer 19

ANS: B
Rationale: Cimetidine is associated with several drug-drug interactions. This drug does
not cause bowel incontinence, abdominal pain, or heat intolerance.

Question 20

A client has recently received a diagnosis of gastric cancer; the nurse is aware of the
importance of assessing the client’s level of anxiety. Which of the following actions is
most likely to accomplish this?
A. The nurse gauges the client’s response to hypothetical outcomes.
B. The client is encouraged to express fears openly.
C. The nurse provides detailed and accurate information about the disease.
D. The nurse closely observes the client’s body language.

Answer 20

ANS: B
Rationale: Encouraging the client to discuss his or her fears and anxieties is usually the
best way to assess a client’s anxiety. Presenting hypothetical situations is a surreptitious
and possibly inaccurate way of assessing anxiety. Observing body language is part of
assessment, but it is not the complete assessment. Presenting information may alleviate
anxiety for some clients, but it is not an assessment.

Question 21

A nurse is caring for a client who has a diagnosis of GI bleed. During shift assessment,
the nurse finds the client to be tachycardic and hypotensive, and the client has an episode
of hematemesis while the nurse is in the room. In addition to monitoring the client’s vital
signs and level of conscious, what would be a priority nursing action for this client?
A. Place the client in a prone position.
B. Provide the client with ice water to slow any GI bleeding.
C. Prepare for the insertion of an NG tube.
D. Notify the health care provider.

Answer 21

ANS: D
Rationale: The nurse must always be alert for any indicators of hemorrhagic gastritis,
which include hematemesis (vomiting of blood), tachycardia, and hypotension. If these
occur, the health care provider is notified and the client’s vital signs are monitored as the
client’s condition warrants. Putting the client in a prone position could lead to aspiration.
Giving ice water is contraindicated as it would stimulate more vomiting.

Question 22

A nurse is caring for a client hospitalized with an exacerbation of chronic gastritis.
What health promotion topic should the nurse emphasize?
A. Strategies for maintaining an alkaline gastric environment
B. Safe technique for self-suctioning
C. Techniques for positioning correctly to promote gastric healing
D. Strategies for avoiding irritating foods and beverages

Answer 22

ANS: D
Rationale: Measures to help relieve pain include instructing the client to avoid foods and
beverages that may be irritating to the gastric mucosa and instructing the client about
the correct use of medications to relieve chronic gastritis. An alkaline gastric environment
is neither possible nor desirable. There is no plausible need for self-suctioning.
Positioning does not have a significant effect on the presence or absence of gastric
healing.

Question 23

A client with gastritis required hospital treatment for an exacerbation of symptoms
and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When
planning the client’s continuing care in the home setting, what assessment question is
most relevant?
A. “Does anyone in your family have experience at giving injections?”
B. “Are you going to be anywhere with strong sunlight in the next few months?”
C. “Are you aware of your blood type?”
D. “Do any of your family members have training in first aid?”

Answer 23

ANS: A
Rationale: Clients with malabsorption of vitamin B12 need information about lifelong
vitamin B12 injections; the nurse may instruct a family member or caregiver how to
administer the injections or make arrangements for the client to receive the injections
from a health care provider. Questions addressing sun exposure, blood type and first aid
are not directly relevant.

Question 24

A client comes to the clinic reporting pain in the epigastric region. What statement by
the client is specific to the presence of a duodenal ulcer?
A. “My pain resolves when I have something to eat.”
B.“The pain begins right after I eat.”
C. “I know that my father and my grandfather both had ulcers.”
D. “I seem to have bowel movements more often than I usually do.”

Answer 24

ANS: A
Rationale: Pain relief after eating is associated with duodenal ulcers. This type of ulcer is
not associated with family history or increased frequency of bowel movements. Pain
immediately after eating is typical of gastric ulcers, not duodenal.

Question 25

The nurse is admitting a client whose medication regimen includes regular injections
of vitamin B12. The nurse should question the client about a history of:
A. total gastrectomy.
B. bariatric surgery.
C. diverticulitis.
D. gastroesophageal reflux disease (GERD).

Answer 25

ANS: A
Rationale: If a total gastrectomy is performed, injection of vitamin B12 will be required
for life, because intrinsic factor, secreted by parietal cells in the stomach, binds to vitamin
B12 so that it may be absorbed in the ileum. Bariatric surgery, diverticulitis and GERD do
not necessitate total gastrectomy and subsequent vitamin B12 supplementation.

Question 26

A client has experienced symptoms of dumping syndrome following gastric surgery.
To what physiologic phenomenon does the nurse attribute this syndrome?
A. Irritation of the phrenic nerve due to diaphragmatic pressure
B. Chronic malabsorption of iron and vitamins A and C
C. Reflux of bile into the distal esophagus
D. Influx of extracellular fluid into the small intestine

Answer 26

ANS: D
Rationale: The rapid bolus of hypertonic food from the stomach to the small intestines
draws extracellular fluid into the lumen of the intestines to dilute the high concentrations
of electrolytes and sugars, which results in intestinal dilation, increased intestinal transit,
hyperglycemia, and the rapid onset of GI and vasomotor symptoms, which characterizes
dumping syndrome. It is not a result of phrenic nerve irritation, malabsorption, or bile
reflux.

Question 27

The nurse is providing care for a client who has recently been diagnosed with chronic
gastritis. What health practice should the nurse address when teaching the client to limit
exacerbations of the disease?
A. Performing 15 minutes of physical activity at least three times per week
B. Avoiding taking aspirin to treat pain or fever
C. Taking multivitamins as prescribed and eating organic foods whenever possible
D. Maintaining a healthy body weight

Answer 27

ANS: B
Rationale: Aspirin and other NSAIDs are implicated in chronic gastritis because of their
irritating effect on the gastric mucosa. Organic foods and vitamins confer no protection.
Exercise and a healthy body weight are beneficial to overall health but do not prevent
gastritis.

Question 28

A client has just been diagnosed with acute gastritis after presenting in distress to the
emergency department with abdominal symptoms. Which of the following actions should
the nurse prioritize?
A. Teaching the client about necessary nutritional modification
B. Helping the client weigh treatment options
C. Teaching the client about the etiology of gastritis
D. Providing the client with physical and emotional support

Answer 28

ANS: D
Rationale: For acute gastritis, the nurse provides physical and emotional support and
helps the client manage the symptoms, which may include nausea, vomiting, heartburn,
and fatigue. The scenario describes a newly diagnosed client; teaching about the etiology
of the disease, lifestyle modifications, or various treatment options would be best
provided at a later time.

Question 29

A client is undergoing diagnostic testing for a tumor of the small intestine. What are
the most likely symptoms that prompted the client to first seek care?
A. Hematemesis and persistent sensation of fullness
B. Abdominal bloating and recurrent constipation
C. Intermittent pain and bloody stool
D. Unexplained bowel incontinence and fatty stools

Answer 29

ANS: C
Rationale: When the client is symptomatic from a tumor of the small intestine, benign
tumors often present with intermittent pain. The next most common presentation is
occult bleeding. The other listed signs and symptoms are not normally associated with
the presentation of small intestinal tumors.

Question 30

A client with a history of peptic ulcer disease has presented to the emergency
department (ED) in distress. What assessment finding would lead the ED nurse to
suspect that the client has a perforated ulcer?
A. The client has abdominal bloating that developed rapidly.
B. The client has a rigid, “board-like” abdomen that is tender.
C. The client is experiencing intense lower right quadrant pain.
D. The client is experiencing dizziness and confusion with no apparent
hemodynamic changes.

Answer 30

ANS: B
Rationale: An extremely tender and rigid (board-like) abdomen is suggestive of a
perforated ulcer. None of the other listed signs and symptoms is suggestive of a
perforated ulcer.

Question 31

Diagnostic testing of a client with a history of dyspepsia and abdominal pain has
resulted in a diagnosis of gastric cancer. The nurse’s anticipatory guidance should include
what information?
A. The possibility of surgery, chemotherapy and radiotherapy
B. The possibility of needing a short-term or long-term colostomy
C. The benefits of weight loss and exercise as tolerated during recovery
D. The good prognosis for clients who are treated for gastric cancer

Answer 31

ANS: A
Rationale: Treatment of gastric cancer is usually multimodal, but does not necessitate a
colostomy. Weight loss is not a goal during recovery; exercise is not a high priority and
may be unrealistic. The prognosis for clients with gastric cancer is generally poor.

Question 32

An adult client with a history of dyspepsia has been diagnosed with chronic gastritis.
The nurse’s health education should include what guidelines? Select all that apply.
A. Avoid drinking alcohol
B. Adopt a low-residue diet
C. Avoid nonsteroidal anti-inflammatories
D. Take calcium gluconate as prescribed
E. Prepare for the possibility of surgery

Answer 32

ANS: A, C
Rationale: Clients with chronic gastritis are encouraged to avoid alcohol and NSAIDs.
Calcium gluconate is not a common treatment and the condition is not normally treated
with surgery. Dietary modifications are usually recommended, but this does not
necessitate a low-residue diet

Question 33

The nurse is providing care for a client whose peptic ulcer disease will be treated with
a Billroth I procedure (gastroduodenostomy). Which statement(s) by the client indicates
effective knowledge of the procedure? Select all that apply.
A. “I will be at risk of developing diarrhea, nausea, and feeling light-headed after
eating.”
B. “It is likely that I will need to receive nutrition directly into my veins.”
C. “One of my nerves, the vagus nerve, may be cut during the surgery.”
D. “I can eat a normal diet again after 3 to 5 weeks.”
E. “This surgery will remove part of my stomach and colon.”

Answer 33

ANS: A, C
Rationale: This surgery carries a risk for dumping syndrome and may be performed with
a truncal vagotomy, in which the vagus nerve is severed. Dumping syndrome is a
condition in which food empties rapidly from the stomach to the duodenum, resulting in
diarrhea, nausea, and feeling light-headed after eating a meal. Parenteral nutrition is not
expected, though life-long dietary modifications will be necessary. A portion of the
duodenum is removed, but not the colon.

Question 34

A client has come to the clinic reporting pain just above her umbilicus. When
assessing the client, the nurse notes Sister Mary Joseph nodules. The nurse should refer
the client to the primary provider to be assessed for what health problem?
A. A GI malignancy
B. Dumping syndrome
C. Peptic ulcer disease
D. Esophageal/gastric obstruction

Answer 34

ANS: A
Rationale: Palpable nodules around the umbilicus, called Sister Mary Joseph nodules, are
a sign of a GI malignancy, usually a gastric cancer. This would not be a sign of dumping
syndrome, peptic ulcer disease, or esophageal/gastric obstruction

Question 35

A client with gastric cancer has been scheduled for a total gastrectomy. During the
preoperative assessment, the client confides in the nurse feeling the surgery will
“mutilate” the client’s body. The nurse should plan interventions that address what
nursing diagnosis?
A. Disturbed body image
B. Deficient knowledge related to the risks of surgery
C. Anxiety about the surgery
D. Low self-esteem

Answer 35

ANS: A
Rationale: The client’s choice of words (“mutilate”) suggests a change in body image.
This may or may not be rooted in anxiety or a lack of knowledge. It may cause an
eventual reduction in self-esteem but the essence of the statement is the client’s body
image.