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Chapter 46: Management of Patients with Gastric and DuodenalDisorders A nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When teachinpatient about his new diagnosis, how should the nurse best describe a peptic ulcer? g the A) Inflammation of the lining of the stomach B)...

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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter46:ManagementofPatientswithGastricandDuodenal Disorders  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

Ans:

B Feedback: 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.

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?

Ans:

A Feedback: 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.

3.

A)

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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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) Ans:

876

Thismedicationwillhelpyourstomachliningtorepairitself.

A Feedback: 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.

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.

Ans:

D Feedback: 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.

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.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

877

C Feedback: 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.

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.

Ans:

B Feedback: 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.

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.

Ans:

C Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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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. 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

Ans:

A Feedback: 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.

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(Gtube)

B)

Gastrointestinaldecompressionbynasogastrictube

C)

Periodicassessmentforesophagealdistension

D)

MonthlyadministrationofinjectionsofvitaminB12

Ans:

D Feedback: 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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

879

isunlikely. 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) Ans:

TheH.pylorimicroorganismisendemicinwarm,moistclimates.

B Feedback: 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.

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

Ans:

A Feedback: 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.

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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Excessivestomachacidsecretion

C)

Anincompetentpyloricsphincter

D)

Ametabolicacidbaseimbalance

Ans:

A

880

Feedback: 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. 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.

Ans:

D Feedback: 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.

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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

881

A Feedback: 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.

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.

Ans:

C Feedback: 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.

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

Ans:

A

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Feedback: 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. 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

Ans:

C Feedback: FollowingaBillrothI,thepatient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.

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AandC

C)

Refluxofbileintothedistalesophagus

D)

Asuddenreleaseofpeptides

Ans:

D Feedback: Formanyyears,ithadbeentheorizedthatthehypertonicgastricfoodbolusesthatquicklytransitinto theintestinesdrewextracellularfluidfromthecirculatingbloodvolumeintothesmallintestinesto dilutethehighconcentrationofelectrolytesandsugars,resultinginsymptoms.Now,itisthoughtthat thisrapidtransitofthefoodbolusfromthestomachintothesmallintestinesinsteadcausesarapidand

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exuberantreleaseofmetabolicpeptidesthatareresponsibleforthesymptomsofdumpingsyndrome.It isnotaresultofphrenicnerveirritation,malabsorption,orbilereflux. 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

Ans:

B Feedback: Patientsseekingbariatricsurgeryshouldbefreeofseriousmentaldisordersandmotivatedtocomply withlifestylechangesrelatedtoeatingpatterns,dietarychoices,andelimination.Whileassessmentof knowledgeaboutcausesofobesityanditsassociatedrisksaswellasinsightintothereasonswhy previousdietshavebeenineffectiveareincludedintheclientsplanofcare,thesedonotpredictpositive clientoutcomesfollowingbariatricsurgery.Mostobesepatientshaveanimpairedbodyimageand alterationinself-esteem.Anobesepatientwithapositivebodyimagewouldbeunlikelytoseekthis surgeryunlessheorshewasexperiencingsignificantcomorbidities.

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

Ans:

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

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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.

Ans:

C Feedback: Suppor...