Deck 58: Care of Patients With Stomach Disorders

Question 1

The nurse is caring for a client who has been brought to the emergency department with upper GI bleeding.The client is vomiting copious amounts of bright red blood.Which is the nurse's priority action?

A) Ensure that the client has a patent airway.
B) Start a normal saline IV infusion.
C) Gather equipment to start a saline lavage.
D) Assess the client for causative factors.

Answer 1

Ensure that the client has a patent airway.

Question 2

The nurse is caring for a client with peptic ulcer disease.The client vomits a large amount of undigested food after breakfast.Which intervention does the nurse prepare to provide for the client?

A) Administer a soap suds cleansing enema.
B) Change the client's diet to clear liquids only.
C) Insert a nasogastric (NG) tube to low intermittent suction.
D) Administer prochlorperazine (Compazine) 10 mg IM.

Answer 2

Insert a nasogastric (NG) tube to low intermittent suction.

Question 3

The nurse is caring for a client who is at risk for developing gastritis.Which finding from the client's history leads the nurse to this conclusion?

A) Client is lactose intolerant and cannot drink milk.
B) Client recently traveled to Mexico and South America.
C) Client works at least 60 hours per week in a stressful job.
D) Client takes naproxen sodium (Naprosyn) 500 mg daily for arthritis pain.

Answer 3

Client takes naproxen sodium (Naprosyn) 500 mg daily for arthritis pain.

Question 4

The nurse is teaching a health promotion class about preventing cancer.Which statement by a student indicates understanding of gastric cancer development?

A) "I should skip my morning bacon and egg sandwich to reduce my risk of gastric cancer."
B) "I have been lactose intolerant for many years, so I should have a yearly test for gastric cancer."
C) "I should switch from regular to decaffeinated coffee to reduce my risk of gastric cancer."
D) "I am at low risk for developing gastric cancer because I am a vegetarian and I eat only organic produce."

Question 5

The nurse is caring for a client with a gastric ulcer who suddenly develops sharp mid-epigastric pain.The nurse notes that the client's abdomen is hard and very tender to light palpation.Which is the priority action of the nurse?

A) Place the client in a knee-chest position.
B) Prepare the client for emergency surgery.
C) Insert a nasogastric (NG) tube to low intermittent suction.
D) Assess the client's pain and administer analgesics.

Question 6

The nurse is caring for a client with peptic ulcer disease.Which assessment finding indicates to the nurse that the client most likely has an ulcer in the stomach rather than in the duodenum?

A) Body mass index (BMI) is 16.6.
B) Stool is positive for occult blood.
C) Client has had four ulcers in the last 5 years.
D) Hemoglobin is 13 g/dL and hematocrit is 42%.

Question 7

A client has been taking an antacid for several weeks without improvement in symptoms.Which response by the nurse is most helpful?

A) "Tell me exactly how you take your antacid."
B) "Would you be willing to try a more expensive medication?"
C) "Are you sure you are taking this exactly as ordered?"
D) "Let's ask the health care provider if the dose can be doubled."

Question 8

The nurse is providing discharge teaching for a client who has peptic ulcer disease caused by Helicobacter pylori infection.Which statement by the client indicates that additional teaching is needed?

A) "I will avoid drinking coffee, even if it is decaffeinated."
B) "I will take a multivitamin every morning with breakfast."
C) "I will go to my tai chi class to wind down after a busy day."
D) "I will take my medication every day until my heartburn is gone."

Question 9

The nurse is caring for a client with gastritis who will undergo a nuclear medicine GI bleeding study in the morning.What instruction for preparation does the nurse give the client?

A) "You cannot eat anything after midnight."
B) "You should drink several glasses of water in the morning."
C) "You must make arrangements for transportation home."
D) "No special preparations are required for this test."

Question 10

An older client is admitted to the hospital with acute gastritis.The health care provider orders magnesium hydroxide (Mylanta)1 hour and 3 hours after meals and at bedtime.Which action by the nurse is most appropriate?

A) Check the client's renal function studies before giving the drug.
B) Call the health care provider and ask for a different antacid for the client.
C) Assess the client's pain and treat pain if present.
D) Assist the client in ordering bland food from the menu.

Question 11

The nurse is caring for a client with advanced gastric cancer who is scheduled for palliative surgery to relieve gastric outlet obstruction.The client asks the nurse why he should bother having the surgery,because he will not be cured.Which is the nurse's best response?

A) "It will allow the doctors to determine more accurately how long you have to live."
B) "It will relieve the obstruction so you will be more comfortable and able to eat again."
C) "It will remove much of the tumor so that chemotherapy will be more effective."
D) "It will help prevent the tumor from spreading to other parts of your body."

Question 12

The nurse is caring for a client with a history of heart failure and chronic gastritis.The client tells the nurse about taking 2 teaspoons of sodium bicarbonate every night before going to bed to prevent heartburn.Which is the nurse's best response?

A) "You should let the doctor know right away if you develop diarrhea."
B) "I will let your doctor know so a safer antacid can be prescribed for you."
C) "Do not take that with milk, because the combination can cause kidney stones."
D) "Make sure that you mix the sodium bicarbonate with at least 8 ounces of water."

Question 13

The nurse is caring for a female client who has just received a prescription for misoprostol (Cytotec).Which instructions does the nurse provide to the client regarding this medication?

A) "You may dissolve the contents of the capsule in warm water if it is difficult for you to swallow."
B) "Take this medication on an empty stomach just before going to bed every evening."
C) "You will need to stop taking your magnesium hydroxide (Mylanta) now that you are on this drug."
D) "You should add extra fiber to your diet because this medication may cause constipation."

Question 14

The nurse is caring for a client who presents with chronic epigastric pain,heartburn,and anorexia.The client asks the nurse how the doctor can best determine whether the symptoms are caused by gastritis.Which is the nurse's best response?

A) "You will be asked to drink a barium solution while x-rays are taken of your stomach."
B) "The doctor will take a look inside your stomach using a tube with a light on the end of it."
C) "A CT scan of your abdomen will show whether inflammation is present in your stomach."
D) "A blood sample will be sent to the laboratory to determine whether you have a stomach infection or bleeding."

Question 15

The nurse is caring for a client with chronic gastritis.The client asks the nurse how to prevent another flare-up of gastritis.Which is the nurse's best response?

A) "Join a support group to help you stop smoking."
B) "Take a multivitamin with iron and folic acid every day."
C) "Make sure to include plenty of fresh vegetables in your diet."
D) "Make sure that your weight stays within normal limits."

Question 16

The nurse is caring for a client who has just arrived in the emergency department reporting epigastric pain.The client says that emesis earlier in the day looked like coffee grounds.What does the nurse prepare to do for the client first?

A) Check the client's stool for occult blood.
B) Insert 18-gauge IV lines with normal saline infusions.
C) Insert a nasogastric tube and prepare for gastric lavage.
D) Determine whether the client has a history of ulcers.

Question 17

The nurse is caring for a client who recently has undergone a partial gastrectomy.Two hours after eating lunch,the client becomes dizzy,diaphoretic,and confused.Which is the nurse's priority action?

A) Check the client's blood sugar level.
B) Increase the client's IV infusion rate.
C) Auscultate the client's bowel sounds.
D) Place the client in high Fowler's position.

Question 18

The nurse is caring for a client who has recently undergone a partial gastrectomy.The client reports becoming dizzy and sweaty with heart palpitations about 2 hours after eating.The client is now afraid to eat anything.Which is the nurse's best response?

A) "Drink at least 6 ounces of fluid before each meal."
B) "Try a clear liquid diet for the next few days."
C) "You probably should avoid dairy products."
D) "Limit carbohydrate intake with meals."

Question 19

The nurse is caring for a client with suspected upper GI bleeding.The nurse inserts a nasogastric (NG)tube for gastric lavage and checks placement of the tube in the stomach.When fluid is aspirated from the tube,the pH is found to be 6.Which is the priority action of the nurse?

A) Obtain an order for a stat chest x-ray.
B) Auscultate over the lung fields bilaterally.
C) Assess whether the tube is coiled in the client's throat.
D) Auscultate over the epigastric area while instilling air.

Question 20

The home care nurse is caring for a client who has recently undergone a subtotal gastrectomy.The nurse notes that the client's tongue is shiny and beefy red.Which assessment question does the nurse ask the client regarding this finding?

A) "Have you been taking your multivitamin every day?"
B) "How much weight have you lost since your surgery?"
C) "Have you been experiencing heartburn or nausea after eating?"
D) "What kind of mouthwash do you use after you brush your teeth?"

Question 21

The nurse is to insert a nasogastric (NG)tube for a client with upper GI bleeding.Which instruction does the nurse give to the client before starting the procedure?

A) "You may take some sips of water when I begin to insert the tube into your nose."
B) "Please hold your breath when I insert the tube through your nose."
C) "Tilt your head down to your chest when the tube gets to the back of your throat."
D) "The distance from the end of your nose to your navel tells me which size tube to use."

Question 22

The nurse is caring for a client who reports persistent epigastric pain,heartburn,and nausea,despite faithfully taking ranitidine (Zantac),aluminum hydroxide (Amphojel),and metronidazole (Flagyl)as prescribed.Which is the nurse's best response?

A) "Is your pain better or worse after you eat?"
B) "Have you tried elevating the head of your bed at night?"
C) "Have you been taking the Amphojel and Flagyl together?"
D) "Have you been experiencing foul-smelling diarrhea lately?"

Question 23

The nurse is caring for a client who has recently undergone a partial gastrectomy.The client asks the nurse which foods would be best for him to have for breakfast.Which menu items does the nurse recommend for the client?

A) Blueberry pancakes with maple syrup
B) A half-grapefruit with a blueberry muffin
C) Plain bagel with margarine or butter
D) Raisin bran with milk and artificial sweetener
E) Scrambled eggs with cheese and a slice of bacon
F) One half cup of cottage cheese with canned pears

Question 24

The nurse is caring for a client who has received multiple serious injuries in a motor vehicle accident.The client asks the nurse why ranitidine (Zantac)is prescribed because she does not have any abdominal pain.Which is the nurse's best response?

A) "It will help prevent the development of a stomach ulcer from the stress of your injuries."
B) "It will help prevent aspiration pneumonia when you are anesthetized during surgery tomorrow."
C) "It will help your throat heal after it was irritated from the nasogastric tube."
D) "It will help prevent nausea and vomiting from the narcotic pain medications that you are taking."

Question 25

The nurse is caring for a client who will be discharged from the hospital following surgery for advanced gastric cancer.The client's daughter verbalizes the fear that she will not be able to manage her parent's symptoms adequately at home.Which is the nurse's best response?

A) "The nurses have taught you everything you need to know to care for your parent."
B) "Don't worry, the pain pills will keep your parent comfortable until the end."
C) "I will ask the social worker to arrange for a hospice nurse to help you at home."
D) "I will ask the health care provider to review the care instructions with you again."

Question 26

A client has returned to the nursing unit after esophagogastroduodenoscopy (EGD).Which action by the nurse takes priority?

A) Keep the client on strict bedrest for 8 hours.
B) Delegate taking vital signs to the nursing assistant.
C) Increase the IV rate to flush the kidneys.
D) Assess the client's gag reflex.

Question 27

The nurse is caring for a client who will undergo a gastrectomy the following day.Which interventions are included in the postoperative plan of care for the client?

A) Monitor and record accurate intake and output (I&O).
B) Remind the client to use the incentive spirometer twice daily.
C) Change abdominal dressings daily using medical asepsis.
D) Remind the client daily to use patient-controlled analgesia (PCA) before pain becomes severe.
E) Keep the head of the client's bed elevated whenever possible.
F) Irrigate the nasogastric tube with normal saline every 8 hours PRN.

Question 28

A client with Zollinger-Ellison syndrome will be admitted to the medical unit.Which intervention does the nurse include in the client's nursing plan of care?

A) Performing a urine test for ketones every morning before breakfast
B) Performing perineal care and applying a moisture barrier twice daily
C) Assessing the abdomen for fluid wave and shifting dullness every 8 hours
D) Keeping 2 units of packed red blood cells on hold at all times

Question 29

The nurse is caring for a client with a nasogastric (NG)tube after an episode of GI bleeding.Which interventions are included in the nursing care plan?

A) Monitor and record intake and output every 8 hours.
B) Monitor hemoglobin and hematocrit laboratory values.
C) Ensure that suction is set on high continuous for Levin tubes.
D) Measure the client's girth and/or assess for distention daily.
E) Pin the tube to the client's gown, so it cannot be dislodged.
F) Check vital signs and orthostatic blood pressure every 4 hours and PRN.