Chapter 37- Management of Patients With Gastric and Duodenal Disorders

1. The patient has been diagnosed with a peptic ulcer. The patient asks the nurse, What is a peptic ulcer? Which of the following best describes 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) Bacterial invasion of the stomach wall Ans: B Difficulty: Easy 2. The nurse asks the patient with a peptic ulcer to describe his pain. A patient with a peptic ulcer usually describes the pain as: A) Gnawing C) Overdistended feeling B) Sharp stabbing D) Cramping or aching Ans: A Difficulty: Moderate 3. A patient has been prescribed ranitidine. Which of the following statements would indicate that the patient correctly understands the action of this medication? A) The medication inhibits acid secretions. B) The medication is an antibiotic. C) The medication is an analgesic. D) The medication will repair my ulcer. Ans: A Difficulty: Moderate 4. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by: A) Eating C) Suppressing emesis B) Drinking milk D) Having a bowel movement Ans: A Difficulty: Moderate 5. A patient admitted with a peptic ulcer complains of right shoulder pain and is hypotensive. The nurse anticipates that the causes for these symptoms are related to: A) Improper positioning in the bed C) Angina B) Ulcer perforation D) A pulmonary infection Ans: B Difficulty: Difficult 6. The nurse is concerned that the patient is experiencing progressive gastric cancer when she assesses which symptom? A) Stomach pain relieved with antacids B) Bloating C) Diarrhea D) Anemia Ans: D Difficulty: Moderate 7. The patient is being discharged after gastric surgery. What is an appropriate discharge
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A) B) C) D)

outcome for this patient? The patient's bowel movements are loose. The patient eats three meals a day. The patient maintains a reasonable weight. The patient consumes a diet high in calcium. Ans: C Difficulty: Moderate 8. The nurse is bringing the meal tray to a patient who is receiving tetracycline therapy for the eradication of Helicobacter pylori. Upon taking the cover off of the tray, the nurse recognizes that the patient will not be allowed to eat which of the following foods? A) Red meat B) Yogurt C) Whole wheat bread D) Nuts Ans: B Difficulty: Moderate 9. The nurse is receiving a report from the PACU about a patient who is returning to the unit after a Billroth II (gastrojejunostomy). The nurse will assess for which complication related to this procedure? A) Feeling of hunger B) Constipation C) Feeling of fullness D) Gastric reflux Ans: C Difficulty: Difficult

10. The nurse is caring for a patient who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the patient to: A) Restrict fluid intake to 1 qt (1000 mL)/day. B) Drink liquids only with meals. C) Maintain NPO status. D) Drink liquids only between meals. Ans: D Difficulty: Difficult 11. During a routine follow-up examination, the nurse updates the patient's medication history. The patient currently receives prednisone therapy. Concomitant use of an agent from which of the following classes could increase the risk of peptic ulcer disease? A) Antidiabetic agents administered orally B) Nonsteroidal anti-inflammatory drugs (NSAIDs) C) Beta-adrenergic blockers D) Contraceptive agents administered orally Ans: B Difficulty: Moderate 12. A patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use is prescribed misoprostol (Cytotec). The nurse would be most accurate in informing the patient that the drug: A) Reduces the stomach's volume of hydrochloric acid

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B) C) D)

Increases the speed of gastric emptying Protects the stomach's lining Increases lower esophageal sphincter pressure Ans: C Difficulty: Moderate

13. The nurse is developing a teaching plan for a patient who has undergone bariatric surgery. Which information listed below is essential to include? A) Drink a minimum of 90 cc of fluid with each meal. B) Eat 6 small meals daily spaced at equal intervals. C) Choose foods high in carbohydrates especially simple sugars. D) Limit calories to no more than 1800 daily. Ans: B Difficulty: Moderate 14. The nurse is assessing an obese patient who expresses an interest in bariatric surgery. The nurse knows that in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate which of the following? A) Knowledge of the causes of obesity and its associated risks B) Emotional stability and understanding of required lifestyle changes C) Positive body image and high self-esteem D) Insight into why their past weight loss efforts failed Ans: B Difficulty: Moderate 15. The nurse is caring for a 34-year-old obese female patient who underwent gastric banding 3 days ago. Essential postoperative teaching for this patient should include instruction related to the importance of abstaining from which of the following for the next two years? A) Multivitamin supplements C) Antidepressants B) Pregnancy D) Control-top panty hose Ans: B Difficulty: Moderate 16. A patient is admitted to the emergency room after a suicide attempt during which she ingested liquid drain cleaner. Her diagnosis is acute gastritis and esophagitis. Which of the following nursing actions is a priority when caring for this patient? A) Induce vomiting to minimize risk of esophageal damage. B) Prepare the patient for an immediate endoscopy. C) Administer an acidic antidote such as diluted vinegar. D) Place the patient in high-Fowler's position to eliminate reflux. Ans: C Difficulty: Moderate 17. A middle-age patient presents at the community clinic with abdominal pains and heartburn, which he says have persisted for several days following a particularly spicy

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A) B) C) D)

meal. Which of the following complications would the nurse be particularly likely to assess for? Esophageal or pyloric obstruction related to scarring Acute systemic infection related to peritonitis Gastric hyperacidity related to excessive gastrin secretion Chronic referred pain in the right shoulder Ans: A Difficulty: Moderate

18. The nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below should the nurse consider most significantly related to the etiology of the patient's health problem? A) Consumes one or more protein drinks daily. B) Takes over-the-counter antacids frequently throughout the day. C) Smokes two packs of cigarettes daily. D) Reports a history of social drinking on a weekly basis. Ans: C Difficulty: Difficult 19. The nurse is assisting a patient with a peptic ulcer to select his dinner menu. Which beverage would be most appropriate? A) Vanilla milkshake C) Unsweetened iced tea B) Decaffeinated coffee D) Room temperature grape juice Ans: D Difficulty: Moderate 20. A patient presents with vomiting and burning in his midepigastrium. The nurse knows that to confirm peptic ulcer disease, the physician is likely to order a diagnostic test to detect the presence of: A) Infection with Helicobacter pylori C) Gastric irritation caused by NSAIDs B) Excessive stomach acid secretion D) Overconsumption of spicy foods Ans: A Difficulty: Easy 21. A patient is admitted to the postanesthesia care unit following resection of a gastric tumor. In which position should the patient be placed to facilitate both patient comfort and gastric emptying? A) Semi-Fowler's B) Dorsal recumbent C) Side-lying D) Left Simm's Ans: A Difficulty: Moderate 22. The nurse is caring for a patient who experienced a gastric hemorrhage. The bleeding has been controlled, and his condition is now stable. The nurse's priority should be frequent assessment of the patient for which of the following? A) Tachycardia, hypotension, and tachypnea B) Tarry, foul smelling stools

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C) D)

Coffee ground material in the nasogastric tube drainage Irritation of the nares and nasal mucosa Ans: A Difficulty: Difficult

23. The nurse is assessing a patient on antibiotic therapy who requests more information about the typical causes of H. pylori infection. It would be appropriate for the nurse to instruct the patient that: A) Most affected patients acquired the infection during international travel. B) Infection typically occurs due to ingestion of contaminated food and water. C) A genetic factor predisposing individuals to H. pylori infection is having type A blood. D) Person-to-person transmission of the H. pylori organism does not occur. Ans: B Difficulty: Easy 24. The nurse is preparing for a home visit to a patient discharged following a total gastrectomy for treatment of gastric cancer. The nurse anticipates that the plan of care is most likely to include which of the following nursing actions? A) Encouraging the patient to eat small, high-fiber meals at frequent intervals B) Gastrointestinal decompression by the nasogastric tube C) Periodic assessment for esophageal distension D) Monthly administration of injections of vitamin B Ans: D Difficulty: Moderate 25. The distressing symptoms of dumping syndrome result from the occurrence of which of the following physiological events? 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) Osmotic transport of extracellular fluid into the gastrointestinal tract Ans: D Difficulty: Difficult

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