NUR212CH58

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TomWruble
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212033
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NUR212CH58
Updated:
2013-05-03 05:30:57
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nur212q1 Care Patients Stomach Disorders nur212e1
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Care of Patients with Stomach Disorders
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  1. (58) The nurse and the dietitian are planning sample diet menus for the client who is experiencing dumping syndrome. Which sample meal is best for this client?

    A. Chicken salad on whole wheat bread
    B. Chicken and rice
    C. Cobb salad with buttermilk ranch dressing
    D. Liver and onions
    B. Chicken and rice

    Chicken and rice is the only selection suitable for the client who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products.

    Not be allowed to have any mayonnaise and can have whole wheat bread only in very limited amounts.

    Generally -
    Several small meals daily
    Relatively high fat and protein content
    Low roughage
    Relatively low carbohydrate content
    No milk, sweets, or sugars
    Liquid between meals only
    (this multiple choice question has been scrambled)
  2. (58) The client with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 lbs. of body weight has been regained. The client is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this client?

    A. Explain to the client the importance of drinking the enteral supplements prescribed.
    B. Ask the client's family to try to persuade the client to drink the supplements.
    C. Inform the client that a nasogastric tube may be necessary if he or she fails to comply.
    D. Ask the client if a change in flavor would make the supplement more palatable.
    D. Ask the client if a change in flavor would make the supplement more palatable.
    (this multiple choice question has been scrambled)
  3. (58) The client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority?

    A. Detailed account of what occurred during the client's surgical procedure
    B. Copy of the diet plan prepared for the client by the hospital dietitian
    C. Schedule of the client's follow-up examinations and x-ray assessments
    D. Information on family members' progress in learning how to perform dressing changes
    C. Schedule of the client's follow-up examinations and x-ray assessments

    Because recurrence of gastric cancer is common, it will be a priority for the client to have follow-up examinations and x-rays, so that a recurrence can be detected quickly.
    (this multiple choice question has been scrambled)
  4. (58) The client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response?

    A. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis."
    B. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop."
    C. "What has your doctor told you about how your gastritis developed?"
    D. "Yes, a familial tendency to inherit Crohn's disease as well as gastritis has been reported. Have your other family members been tested for Crohn's disease?''
    B. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop."

    Crohn's disease may be an underlying disease process associated with gastritis, but it is not known to be a direct cause of the disease.

    Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs.

    Although Crohn's disease tends to run in families, gastritis is a symptom of other disease processes and is not a disease process in and of itself.
    (this multiple choice question has been scrambled)
  5. (58) The client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response?

    A. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them."
    B. "No, they probably won't be useful. You should use only prescription medications in your treatment plan."
    C. "These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen."
    D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."
    C. "These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen."
    (this multiple choice question has been scrambled)
  6. (58) The nurse is teaching the client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates correct understanding of the nurse's instruction?

    A. "I will need to take vitamin B12 shots for the rest of my life."
    B. "Small meals should be eaten about six times a day."
    C. "It is okay to continue to drink coffee in the morning when I get to work."
    D. "Ibuprofen (Advil, Motrin, others) can be taken for my headaches instead of aspirin."
    B. "Small meals should be eaten about six times a day."

    The client with chronic gastritis will need to take vitamin B12 shots only if he or she has pernicious anemia.

    The client with chronic gastritis should not use ibuprofen or aspirin.
    (this multiple choice question has been scrambled)
  7. (58) The client is exhibiting symptoms of gastritis. The nurse is assessing the client to determine whether the form of gastritis being experienced is acute or chronic. Which data are correlated with a diagnosis of chronic gastritis?

    A. Hematemesis and anorexia
    B. Anorexia, nausea, and vomiting
    C. Frequent use of corticosteroids
    D. Treatment with radiation therapy
    D. Treatment with radiation therapy

    Treatment with radiation therapy is known to be associated with the development of chronic gastritis.

    Anorexia, nausea, and vomiting are all symptoms of acute gastritis.

    Corticosteroid use is associated with acute gastritis.

    Hematemesis and anorexia are more likely to be symptoms of acute gastritis.
    (this multiple choice question has been scrambled)
  8. (58) The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which syndrome is most significant in determining whether the client's ulceration is duodenal as opposed to gastric in origin?

    A. The client is a man older than 50 years.
    B. The client has a malnourished appearance.
    C. Pain occurs 1 1/2 to 3 hours after a meal, usually at night.
    D. Pain is worsened by the ingestion of food.
    C. Pain occurs 1 1/2 to 3 hours after a meal, usually at night.

    A key symptom characteristic of duodenal ulcers is that pain usually awakens the client between 1 AM and 2 AM, occurring 1 1/2 to 3 hours after a meal.

    Pain that is worsened with ingestion of food is a key feature of gastric ulcers.

    A malnourished appearance is a key feature of gastric ulcers.
    (this multiple choice question has been scrambled)
  9. (58) A key symptom characteristic of AAA ulcers is that pain usually awakens the client between 1 AM and 2 AM, occurring 1 1/2 to 3 hours after a meal.
    A) duodenal
  10. (58) Pain that is worsened with ingestion of food is a key feature of AAA ulcers.
    A) gastric
  11. (58) A malnourished appearance is a key feature of AAA ulcers.
    A) gastric
  12. (58) T/F: The client is a man older than 50 years. This fact is associated with gastric ulcers.
    False: This is a finding that could apply to either type of ulcer: duodenal or gastric.
  13. (58) The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority?

    A. Administering intravenous (IV) pain medication
    B. Starting a large-bore intravenous (IV)
    C. Monitoring the client's anxiety level
    D. Preparing equipment for intubation
    B. Starting a large-bore intravenous (IV)

    A large-bore IV should be placed as requested, so that blood products can be administered.
    (this multiple choice question has been scrambled)
  14. (58) The nurse is teaching the client with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge?

    A. "Nizatidine (Axid) needs to be taken three times a day to be effective."
    B. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals."
    C. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night."
    D. "Omeprazole (Prilosec) should be swallowed whole and not crushed."
    A. "Nizatidine (Axid) needs to be taken three times a day to be effective."

    Nizatidine (Axid) is most effective if administered twice daily.
    (this multiple choice question has been scrambled)
  15. (58) T/F: A dose of ranitidine (Zantac) at bedtime should decrease acid production throughout the night.
    True
  16. (58) T/F: Sucralfate (Carafate) should be taken 1 hour before and 3 hours after meals
    False 1 and 2
  17. (58) T/F: Because omeprazole (Prilosec) is a delayed-release capsule, it should be swallowed whole and not crushed.
    True
  18. (58) The nurse is monitoring the client with gastric cancer for signs and symptoms of upper GI bleeding. Which change in vital signs is most indicative of bleeding related to cancer?

    A. Blood pressure from 140/90 to 110/70 mm Hg
    B. Apical pulse from 80 to 72 beats/min
    C. Respiratory rate from 24 to 20 breaths/min
    D. Temperature from 98.9° F to 97.9° F
    A. Blood pressure from 140/90 to 110/70 mm Hg

    A decrease in blood pressure is the most indicative sign of bleeding.
    (this multiple choice question has been scrambled)
  19. (58) The nurse finds a client vomiting coffee ground-type material. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention will be the nurse's first priority?

    A. Initiating enteral nutrition
    B. Administering an H2 antagonist
    C. Administering intravenous (IV) fluids
    D. Administering antianxiety medication
    C. Administering intravenous (IV) fluids

    Administration of IV fluids is necessary to treat the hypovolemia caused by acute GI bleeding.
    (this multiple choice question has been scrambled)
  20. (58) The nurse has placed a nasogastric (NG) tube in the client who has overdosed to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response?

    A. "Saline goes down the tube to help clean out your stomach."
    B. "The doctor requested the tube to be placed just in case it was needed."
    C. "Medicine goes down the tube to help clean out your stomach."
    D. "We'll start feeding you through it once your stomach is cleaned out."
    A. "Saline goes down the tube to help clean out your stomach."

    Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents.
    (this multiple choice question has been scrambled)
  21. (58) The nurse is teaching the client about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the client indicates a need for further teaching?

    A. "It is okay to have a serving of sugar-free pudding."
    B. "I cannot drink alcohol at all."
    C. "Sweetened fruit juice beverages will need to be avoided."
    D. "Ice cream can be eaten in moderation."
    D. "Ice cream can be eaten in moderation."
    (this multiple choice question has been scrambled)
  22. (58) The client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention?

    A. Trying to determine specific concerns that the spouse has regarding dressing changes
    B. Asking the physician for a referral for home health services to assist with dressing changes
    C. Asking the spouse whether other family members could be taught how to change the dressing
    D. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician
    D. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician

    Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician
    (this multiple choice question has been scrambled)
  23. (58) The client is an older woman diagnosed with Zollinger-Ellison syndrome. Which statement made by the client's family demonstrates correct understanding of the disorder?

    A. "Thank goodness she won't have to undergo surgery."
    B. "This is going to be a chronic problem that cannot be cured."
    C. "At least this is not an inherited ailment."
    D. "She may have to be treated with chemotherapy drugs."
    D. "She may have to be treated with chemotherapy drugs."

    The client may undergo treatment with chemotherapeutic agents to reduce the tumor before further treatment can commence.

    It can be cured.

    A familial tendency to develop Zollinger-Ellison syndrome has been noted.

    The only way to cure Zollinger-Ellison syndrome is with surgery.
    (this multiple choice question has been scrambled)
  24. (58) T/F: Zollinger-Ellison syndrome is curable.
    True
  25. (58) The client with peptic ulcer disease (PUD) asks the nurse whether a maternal history of ovarian cancer will cause the client to develop gastric cancer. What is the nurse's best response?

    A. "Have you spoken to your physician about your concerns?"
    B. "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food."
    C. "Yes, it is known that a family history of ovarian cancer will cause someone to develop gastric cancer."
    D. "If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing."
    D. "If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing."

    Although a diet high in pickled, salted, and processed foods does increase the risk for gastric cancer, a family history of specific types of cancer can also increase the risk.
    (this multiple choice question has been scrambled)
  26. (58) Which nursing action is best for the charge nurse to delegate to an experienced licensed practical nurse/vocational nurse (LPN/LVN)?

    A. Document instructions for a client with chronic gastritis about how to use "triple therapy."
    B. Assess the gag reflex for a client who has arrived from the postanesthesia care unit (PACU) after a laparoscopic gastrectomy.
    C. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis.
    D. Re-tape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy.
    C. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis.

    Re-taping the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by licensed nursing staff.
    (this multiple choice question has been scrambled)
  27. (58) The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40, pulse 124, and respiratory rate 26. Which admission request will the nurse implement first?

    A. Infuse lactated Ringer's solution at 200 mL/hr.
    B. Insert nasogastric tube and connect to low intermittent suction.
    C. Type and crossmatch for 4 units of packed red blood cells.
    D. Give pantoprazole (Protonix) 40 mg IV now and then daily.
    A. Infuse lactated Ringer's solution at 200 mL/hr.

    The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia.

    Type and crossmatch for 4 units of packed red blood cells - Incorrect: This will need to be done, but the nurse's immediate concern is correcting the client's hypovolemia.

    All options will need to be done. They are just not the priority.
    (this multiple choice question has been scrambled)
  28. (58) The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request will the nurse implement first?

    A. Insert an indwelling catheter, and check output hourly.
    B. Apply antiembolism stockings.
    C. Give famotidine (Pepcid) 20 mg IV every 12 hours.
    D. Place nasogastric (NG) tube, and connect to suction.
    D. Place nasogastric (NG) tube, and connect to suction.

    To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis.

    Antiembolism stockings will need to be applied to prevent thromboembolism, but the nurse's immediate priority is to minimize the risk for peritonitis.

    All other options are appropriate, but they are not the priority.
    (this multiple choice question has been scrambled)
  29. (58) The nurse working during the day shift on the medical unit has just received report. Which client will the nurse plan to assess first?

    A. Middle-aged client with Zollinger-Ellison syndrome who needs to receive omeprazole (Prilosec) before breakfast
    B. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal
    C. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy
    D. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy
    D. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy

    This client is experiencing symptoms of acute gastric dilation, which can disrupt the suture line. The surgeon should be notified immediately because the nasogastric tube may need irrigation or repositioning.
    (this multiple choice question has been scrambled)
  30. (58) The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil, Motrin, others) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client?

    A. Bismuth subsalicylate (Pepto-Bismol)
    B. Misoprostol (Cytotec)
    C. Metronidazole (Flagyl)
    D. Magnesium hydroxide (Maalox, Mylanta)
    B. Misoprostol (Cytotec)

    Misoprostol (Cytotec) is a prostaglandin analogue that protects against NSAID-induced ulcers. It is a "pain mediator", but in the stomach it protects the mucossal lining.

    Bismuth subsalicylate (Pepto-Bismol) is an antidiarrheal drug that contains salicylates, which can cause bleeding and should be avoided in clients who have peptic ulcer disease (PUD).

    Magnesium hydroxide (Maalox, Mylanta) is an antacid that may be used to neutralize stomach secretions but is not used specifically to help prevent NSAID-induced ulcers.

    Metronidazole (Flagyl) is an antimicrobial agent used to treat Helicobacter pylori infection, i.e. H. pylori
    (this multiple choice question has been scrambled)
  31. (58) Gastritis
    Inflammation of the gastric mucosa
  32. (58) PUD
    Lesion of the mucosal lining of the stomach or duodenum, and possibly the esophagus.
  33. (58) A client who undergoes a gastric resection is at risk for developing dumping syndrome. The nurse monitors the client for:

    A. Extreme thirst
    B. Constipation
    C. Dizziness
    D. Bradycardia
    C. Dizziness

    Rationale:
    Dumping syndrome is the rapid emptying of the gastric contents into the small intestine that occurs after gastric resection. Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vasomotor disturbances such as dizziness, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.
    (this multiple choice question has been scrambled)
  34. (58) Gastritis definition and types
    Inflammation of gastric (stomach) mucosa

    • Acute Gastritis
    • can be caused by H. pylori as well as long-term NSAID use, and less common by staph, strep, and E. coli

    • Chronic Gastritis
    • Type A: inflammation of glands, fundus & body; and is assoc w/ antibodies to parietal cells and intrinsic factor, so an autoimmune cause is likely.
    • Type B: (most common "chronic") usually glands of Antrum, but may be whole stomach and is caused by H. pylori.
    • Atrophic: most often seen in older adults and caused by exposure to toxins (e.g. benzene, lead), H. pylori, or autoimmune
  35. (58) Zollinger–Ellison syndrome
    caused by a non–beta islet cell, gastrin-secreting tumor of the pancreas that stimulates the acid-secreting cells of the stomach to maximal activity, with consequent gastrointestinal mucosal ulceration.

    ZES may occur sporadically or as part of an autosomal dominant familial syndrome called multiple endocrine neoplasia type 1 (MEN 1). The primary tumor is usually located in the pancreas, duodenum or abdominal lymph nodes, but ectopic locations have also been described (e.g., heart, ovary, gallbladder, liver, kidney).
  36. (58) Differential Features of Gastric and Duodenal Ulcers
  37. (58) Side effects: Flagyl
    Consuming ethanol (alcohol) while taking metronidazole has long been thought to have a disulfiram-like reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia (accelerated heart rate), and shortness of breath.
  38. (58) Med Info: Tetracycline
    • Not for renal Pt
    • Not for Kids under 8
    • w/ food
    • NO dairy
    • Photosensitivity
    • Rpt severe nausea, vomoting, dizziness
  39. (58) Meds for H. pylori
    Some combo of:

    • Amoxicillin
    • clarithromycin
    • metronidazole
    • tetracycline
    • flagyl, which cannot be taken with alcohol
  40. (58) Tx of choice for Trichomonas
    Flagyl (metronidazole)
  41. (58) Early and Late signs of Dumping Syndrome
    It is: Gastric dumping syndrome, or rapid gastric emptying is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested.

    "Early" dumping begins concurrently with or immediately succeeding ingestion of a meal.

    • Symptoms of early dumping include:
    • nausea
    • vomiting
    • bloating
    • cramping
    • diarrhea
    • dizziness
    • fatigue

    "Late" dumping happens one to three hours after eating.

    • Symptoms of late dumping include
    • weakness
    • sweating
    • dizziness.
  42. (58) Nasogastric Tubes
    Inform the patient about the procedure and its potential discomfort.

    Position the patient with pillows behind the shoulders.

    Lubricate the tube with a water-soluble lubricant.

    • Measure the length of the tube to be passed:
    • a. Measure from the bridge of the nose to the earlobe to the xiphoid process.
    • b. Indicate this length with a piece of tape on the tube.

    Determine which nostril is more patent.

    Encourage the patient to swallow or drink water if the level ofconsciousness and treatment plan permit.

    • Insert the tube:
    • a. Pass the tube gently into the nasopharynx. Ask the patient to swallow repeatedly while the tube is advanced.
    • b. If resistance is met, rotate the tube slowly, aiming downwardand toward the closer ear.
    • c. In the intubated or semiconscious patient, flex the headtoward the chest while passing the tube.

    Withdraw the tube immediately if any change is noted in respiratory status.

    • Test for tube placement by using these techniques:
    • a. Obtain a sample of the gastric contents by aspirating with a 50-mL catheter-tipped syringe.
    • b. Test the pH of the gastric contents (should be between 1 and3.5).
    • c. Obtain a request for an x-ray study to confirm placement.

    • Connect the tube to suction at low pressure:
    • a. The Levin tube is connected to intermittent low suction.
    • b. The Salem sump or Anderson tube (has pigtail vent) is connected to continuous low suction.

    • Secure the tube to the patient's nose and to his or her gown:
    • a. Tie a slipknot around the tube with a rubber band.
    • b. Pin the rubber band to the gown.

    Check intake and output every 4 hr or more often, as indicated.

    Observe the patient for nausea, vomiting, abdominal fullness, ordistention.

    If irrigation is indicated, use only a normal saline solution.

    Observe the patient for alterations in fluid and electrolyte balance.

    If indicated, instruct the patient about movement that will not dislodge the tube and cause nasal irritation.

    RemoveĀ  the tapeĀ securing the tube to the nose daily and PRN to clean skin; reapply tape.
  43. (58)

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