Deck 46: Management of Patients With Gastric and Duodenal Disorders

Question 1

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

Answer 1

Erosion of the lining of the stomach or intestine

Question 2

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?

Answer 2

Does your pain resolve when you have something to eat?

Question 3

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.

Answer 3

This medication will reduce the amount of acid secreted in your stomach.

Question 4

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.

Question 5

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.

Question 6

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.

Question 7

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.

Question 8

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

Question 9

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 ( $\mathrm{G}$ tube)
B) Gastrointestinal decompression by nasogastric tube
C) Periodic assessment for esophageal distension
D) Monthly administration of injections of vitamin $\mathrm{B}_{12}$

Question 10

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.

Question 11

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

Question 12

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

Question 13

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.

Question 14

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

Question 15

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.

Question 16

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

Question 17

A patient is receiving education about his upcoming Billroth I procedure (gastroduodenostomy). This patient should be informed that he 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

Question 18

A patient has experienced symptoms of dumping syndrome following bariatric 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 $\mathrm{A}$ and $\mathrm{C}$
C) Reflux of bile into the distal esophagus
D) A sudden release of peptides

Question 19

A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what?

A) Knowledge of the causes of obesity and its associated risks
B) Adequate understanding of required lifestyle changes
C) Positive body image and high self-esteem
D) Insight into why past weight loss efforts failed

Question 20

A nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The patient has recently been prescribed misoprostol (Cytotec). What would the nurse be most accurate in informing the patient about the drug?

A) It reduces the stomachs volume of hydrochloric acid
B) It increases the speed of gastric emptying
C) It protects the stomachs lining
D) It increases lower esophageal sphincter pressure

Question 21

A nurse is providing anticipator guidance to a patient who is preparing for bariatric surgery. The nurse learns that the patient is anxious about numerous aspects of the surgery. What intervention is most appropriate to alleviate the patients anxiety?

A) Emphasize the fact that bariatric surgery has a low risk of complications.
B) Encourage the patient to focus on the benefits of the surgery.
C) Facilitate the patients contact with a support group.
D) Obtain an order for a PRN benzodiazepine.

Question 22

A patient 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 patient at this time?

A) Teaching the patient about necessary nutritional modification
B) Helping the patient weigh treatment options
C) Teaching the patient about the etiology of gastritis
D) Providing the patient with physical and emotional support

Question 23

A nurse is providing care for a patient who is postoperative day 2 following gastric surgery. The nurses assessment should be planned in light of the possibility of what potential complications? Select all that apply.

A) Malignant hyperthermia
B) Atelectasis
C) Pneumonia
D) Metabolic imbalances
E) Chronic gastritis

Question 24

A patient is undergoing diagnostic testing for a tumor of the small intestine. What are the most likely symptoms that prompted the patient 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

Question 25

A patient is recovering in the hospital following gastrectomy. The nurse notes that the patient has become increasingly difficult to engage and has had several angry outbursts at various staff members in recent days. The nurses attempts at therapeutic dialogue have been rebuffed. What is the nurses most appropriate action?

A) Ask the patients primary care provider to liaise between the nurse and the patient.
B) Delegate care of the patient to a colleague.
C) Limit contact with the patient in order to provide privacy.
D) Make appropriate referrals to services that provide psychosocial support.

Question 26

A patient has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurses priority intervention?

A) Administration of antiemetics
B) Insertion of an $\mathrm{NG}$ tube for decompression
C) Infusion of hypotonic IV solution
D) Administration of proton pump inhibitors as ordered

Question 27

A patient 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 patient has a perforated ulcer?

A) The patient has abdominal bloating that developed rapidly.
B) The patient has a rigid, boardlike abdomen that is tender.
C) The patient is experiencing intense lower right quadrant pain.
D) The patient is experiencing dizziness and confusion with no apparent hemodynamic changes.

Question 28

Diagnostic imaging and physical assessment have revealed that a patient 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

Question 29

A nurse is performing the admission assessment of a patient whose high body mass index (BMI) corresponds to class III obesity. In order to ensure empathic and patient-centered care, the nurse should do which of the following?

A) Examine ones own attitudes towards obesity in general and the patient in particular.
B) Dialogue with the patient about the lifestyle and psychosocial factors that resulted in obesity.
C) Describe ones own struggles with weight gain and weight loss to the patient.
D) Elicit the patients short-term and long-term goals for weight loss.

Question 30

A patient has been prescribed orlistat (Xenical) for the treatment of obesity. When providing relevant
Health education for this patient, the nurse should ensure the patient is aware of what potential adverse effect of treatment?

A) Bowel incontinence
B) Flatus with oily discharge
C) Abdominal pain
D) Heat intolerance

Question 31

A patient who is obese has been unable to lose weight successfully using lifestyle modifications and has mentioned the possibility of using weight-loss medications. What should the nurse teach the patient about pharmacologic interventions for the treatment of obesity?

A) Weight loss drugs have many side effects, and most doctors think theyll all be off the market in a few years.
B) There used to be a lot of hope that medications would help people lose weight, but its been shown to be mostly a placebo effect.
C) Medications can be helpful, but few people achieve and maintain their desired weight loss with medications alone.
D) Medications are rapidly become the preferred method of weight loss in people for whom diet and exercise have not worked.

Question 32

A patient has been diagnosed with peptic ulcer disease and the nurse is reviewing his prescribed medication regimen with him. What is currently the most commonly used drug regimen for peptic ulcers?

A) Bismuth salts, antivirals, and histamine-2 (H2) antagonists
B) $\quad \mathrm{H} 2$ antagonists, antibiotics, and bicarbonate salts
C) Bicarbonate salts, antibiotics, and ZES
D) Antibiotics, proton pump inhibitors, and bismuth salts

Question 33

A patient who is obese is exploring bariatric surgery options and presented to a bariatric clinic for preliminary investigation. The nurse interviews the patient, analyzing and documenting the data. Which of the following nursing diagnoses may be a contraindication for bariatric surgery?

A) Disturbed Body Image Related to Obesity
B) Deficient Knowledge Related to Risks and Expectations of Surgery
C) Anxiety Related to Surgery
D) Chronic Low Self-Esteem Related to Obesity

Question 34

A patient has recently received a diagnosis of gastric cancer; the nurse is aware of the importance of assessing the patients level of anxiety. Which of the following actions is most likely to accomplish this?

A) The nurse gauges the patients response to hypothetical outcomes.
B) The patient is encouraged to express fears openly.
C) The nurse provides detailed and accurate information about the disease.
D) The nurse closely observes the patients body language.

Question 35

A patient has received a diagnosis of gastric cancer and is awaiting a surgical date. During the preoperative period, the patient should adopt what dietary guidelines?

A) Eat small, frequent meals with high calorie and vitamin content.
B) Eat frequent meals with an equal balance of fat, carbohydrates, and protein.
C) Eat frequent, low-fat meals with high protein content.
D) Try to maintain the pre-diagnosis pattern of eating.

Question 36

A nurse is caring for a patient who has a diagnosis of GI bleed. During shift assessment, the nurse finds the patient to betachycardic and hypotensive, and the patient has an episode of hematemesis while the nurse is in the room. In addition to monitoring the patients vital signs and level of conscious, what would be a priority nursing action for this patient?

A) Place the patient in a prone position.
B) Provide the patient with ice water to slow any GI bleeding.
C) Prepare for the insertion of an NG tube.
D) Notify the physician.

Question 37

A nurse is caring for a patient 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

Question 38

A patient with gastritis required hospital treatment for an exacerbation of symptoms and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the patients 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?

Question 39

A nurse is presenting a class at a bariatric clinic about the different types of surgical procedures offered by the clinic. When describing the implications of different types of surgeries, the nurse should address which of the following topics? Select all that apply.

A) Specific lifestyle changes associated with each procedure
B) Implications of each procedure for eating habits
C) Effects of different surgeries on bowel function
D) Effects of various bariatric surgeries on fertility
E) Effects of different surgeries on safety of future immunizations

Question 40

A patient has come to the clinic complaining of pain just above her umbilicus. When assessing the patient, the nurse notes Sister Mary Josephs nodules. The nurse should refer the patient to the primary care provider to be assessed for what health problem?

A) A GI malignancy
B) Dumping syndrome
C) Peptic ulcer disease
D) Esophageal/gastric obstruction