Capstone: Gastrointestinal (NCLEX)

A nurse should plan to implement which interventions for a child admitted with inorganicfailure to thrive? Select all that apply.

a. Observation of parent-child interactions

b. Assignment of different nurses to care for the child from day to day

c. Use of 28 calorie per ounce concentrated formulas

d. Administration of daily multivitamin supplements

e. Role modeling appropriate adult-child interactions

ADE

The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention?

A. Notify the health care provider (HCP).

B. Administer the prescribed pain medication.

C. Call and ask the operating room team to perform surgery as soon as possible.

D. Reposition the client and apply a heating pad on the warm setting to the client's abdomen.

A

On the basis of the signs and symptoms presented in the question, the nurse should suspect peritonitis and notify the HCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis because of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the HCP probably would perform the surgery earlier than the prescheduled time.

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? Select all that apply.

A. Coffee

B. Chocolate

C. Peppermint

D. Nonfat milk

E. Fried chicken

F. Scrambled eggs

ABCE

Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options 4 and 6 do not promote this effect.

A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client's care plan?

1. Monitoring the temperature

2. Monitoring complaints of heartburn

3. Giving warm gargles for a sore throat

4. Assessing for the return of the gag reflex

4

The nurse places highest priority on assessing for return of the gag reflex. This assessment addresses the client's airway. The nurse also monitors the client's vital signs and for a sudden increase in temperature, which could indicate perforation of the gastrointestinal tract. This complication would be accompanied by other signs as well, such as pain. Monitoring for sore throat and heartburn are also important; however, the client's airway is the priority.

The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply.

A. Nuts

B. Corn

C. Liver

D. Apples

E. Lentils

F. Bananas

ACE

Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of function of the parietal cells. The source of intrinsic factor is lost, which results in an inability to absorb vitamin B12, leading to development of pernicious anemia. Clients must increase their intake of vitamin B12 by increasing consumption of foods rich in this vitamin, such as nuts, organ meats, dried beans, citrus fruits, green leafy vegetables, and yeast.

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer?

A. Bradycardia

B. Numbness in the legs

C. Nausea and vomiting

D. A rigid, boardlike abdomen

D

Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the mid-epigastric area and spreading over the abdomen, which becomes rigid and boardlike. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.

The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify?

A. Leg exercises

B. Early ambulation

C. Irrigating the nasogastric tube

D. Coughing and deep-breathing exercises

C

In a gastrojejunostomy (Billroth II procedure), the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the nasogastric tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically prescribed by the health care provider. In this situation, the nurse should clarify the prescription. Options 1, 2, and 4 are appropriate postoperative interventions.

The nurse is providing discharge instructions to a client following gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome?

A. Ambulate following a meal.

B. Eat high-carbohydrate foods.

C. Limit the fluids taken with meals.

D. Sit in a high Fowler's position during meals.

C

Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a gastrojejunostomy (Billroth II procedure). Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals and to avoid high-carbohydrate foods, including fluids such as fruit nectars; to assume a low Fowler's position during meals; to lie down for 30 minutes after eating to delay gastric emptying; and to take antispasmodics as prescribed.

The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction?

A. "I should increase the fiber in my diet."

B. "I will need to avoid caffeinated beverages."

C. "I'm going to learn some stress reduction techniques."

D. "I can have exacerbations and remissions with Crohn's disease."

A

Crohn's disease is an inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. It is characterized by exacerbations and remissions. If stress increases the symptoms of the disease, the client is taught stress management techniques and may require additional counseling. The client is taught to avoid gastrointestinal stimulants containing caffeine and to follow a high-calorie and high-protein diet. A low-fiber diet may be prescribed, especially during periods of exacerbation.

The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which sign(s)/symptom(s) of duodenal ulcer?

A. Weight loss

B. Nausea and vomiting

C. Pain relieved by food intake

D. Pain radiating down the right arm

C

A frequent symptom of duodenal ulcer is pain that is relieved by food intake. These clients generally describe the pain as a burning, heavy, sharp, or "hungry" pain that often localizes in the mid-epigastric area. The client with duodenal ulcer usually does not experience weight loss or nausea and vomiting. These symptoms are more typical in the client with a gastric ulcer.

A client with hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia?

A. Lying recumbent following meals

B. Consuming small, frequent, bland meals

C. Taking H2-receptor antagonist medication

D. Raising the head of the bed on 6-inch (15 cm) blocks

A

Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying flat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent, and bland meals; use of H2-receptor antagonists and antacids; and elevation of the thorax following meals and during sleep.

A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery?

A. Folate deficiency

B. Malabsorption of fat

C. Intestinal obstruction

D. Fluid and electrolyte imbalance

D

A frequent complication that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of intake and output to prevent this from occurring. Losses require replacement by intravenous infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the postoperative period.

The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching?

A. "I need to limit my intake of dietary fiber."

B. "I need to drink plenty, at least 8 to 10 cups daily."

C. "I need to eat regular meals and chew my food well."

D. "I will take the prescribed medications because they will regulate my bowel patterns."

A

IBS is a functional gastrointestinal disorder that causes chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. Dietary fiber and bulk help to produce bulky, soft stools and establish regular bowel elimination habits. Therefore, the client should consume a high-fiber diet. Eating regular meals, drinking 8 to 10 cups of liquid a day, and chewing food slowly help to promote normal bowel function. Medication therapy depends on the main symptoms of IBS. Bulk-forming laxatives or antidiarrheal agents or other agents may be prescribed.

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?

A. Sweating and pallor

B. Bradycardia and indigestion

C. Double vision and chest pain

D. Abdominal cramping and pain

A

Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

The nurse inspects the color of the drainage from a nasogastric tube on a postoperative client approximately 24 hours after gastric surgery. Which finding indicates the need to notify the health care provider (HCP)?

A. Dark red drainage

B. Dark brown drainage

C. Green-tinged drainage

D. Light yellowish-brown drainage

A

For the first 12 hours after gastric surgery, the nasogastric tube drainage may be dark brown to dark red. Later, the drainage should change to a light yellowish-brown color. The presence of bile may cause a green tinge. The HCP should be notified if dark red drainage, a sign of hemorrhage, is noted 24 hours postoperatively.

After undergoing Billroth I gastric surgery, the client experiences fatigue and complains of numbness and tingling in the feet and difficulties with balance. On the basis of these symptoms, the nurse suspects which postoperative complication?

A. Stroke

B. Pernicious anemia

C. Bacterial meningitis

D. Peripheral arterial disease

B

Billroth I surgery involves removing one half to two thirds of the stomach and reanastomosing the remaining segment of the stomach to the duodenum. With the loss of this much of the stomach, development of pernicious anemia is not uncommon. Pernicious anemia is a macrocytic anemia that most commonly is caused by the lack of intrinsic factor. During a Billroth I procedure, a large portion of the parietal cells, which are responsible for producing intrinsic factor (a necessary component for vitamin B12 absorption), are removed. In this anemia, the red blood cell is larger than usual and hence does not last as long in the circulation as normal red blood cells do, causing the client to have anemia with resultant fatigue. Vitamin B12 also is necessary for normal nerve function. Because of the lack of the necessary intrinsic factor, persons with pernicious anemia also experience paresthesias, impaired gait, and impaired balance. Although the symptoms could possibly indicate the other options listed, pernicious anemia is the most logical based on the surgery the client underwent.

A client experiencing chronic dumping syndrome makes the following comments to the nurse. Which one indicates the need for further teaching?

A. "I eat at least 3 large meals each day."

B. "I eat while lying in a semirecumbent position."

C. "I have eliminated taking liquids with my meals."

D. "I eat a high-protein, low- to moderate-carbohydrate diet."

A

Dumping syndrome describes a group of symptoms that occur after eating. It is believed to result from rapid dumping of gastric contents into the small intestine, which causes fluid to shift into the intestine. Signs and symptoms of dumping syndrome include diarrhea, abdominal distention, sweating, pallor, palpitations, and syncope. To manage this syndrome, clients are encouraged to decrease the amount of food taken at each sitting, eat in a semirecumbent position, eliminate ingesting fluids with meals, and avoid consumption of high-carbohydrate meals.

The nurse obtains an admission history for a client with suspected peptic ulcer disease (PUD). Which client factor documented by the nurse would increase the risk for PUD?

A. Recently retired from a job

B. Significant other has a gastric ulcer

C. Occasionally drinks 1 cup of coffee in the morning

D. Takes nonsteroidal antiinflammatory drugs (NSAIDs) for osteoarthritis

D

Risk factors for PUD include Helicobacter pylori infection, smoking (nicotine), chewing tobacco, corticosteroids, aspirin, NSAIDs, caffeine, alcohol, and stress. When an NSAID is taken as often as is typical for osteoarthritis, it will cause problems with the stomach. Certain medical conditions such as Crohn's disease, Zollinger-Ellison syndrome, and hepatic and biliary disease also can increase the risk for PUD by changing the amount of gastric and biliary acids produced. Recent retirement should decrease stress levels rather than increase them. Ulcer disease in a first-degree relative also is associated with increased risk for an ulcer. A significant other is not a first-degree relative; therefore, no genetic connection is noted in this relationship. Although caffeinated drinks are a known risk factor for PUD, the option states that the client drinks 1 cup of coffee occasionally.

The nurse is caring for a client with ulcerative colitis. Which finding does the nurse determine is consistent with this diagnosis?

A. Hypercalcemia

B. Hypernatremia

C. Frothy, fatty stools

D. Decreased hemoglobin

D

Ulcerative colitis is an inflammatory disease of the large colon. Findings associated with ulcerative colitis include diarrhea with up to 10 to 20 liquid bloody stools per day, weight loss, anorexia, fatigue, increased white blood cell count, increased erythrocyte sedimentation rate, dehydration, hyponatremia, and hypokalemia (not hypercalcemia). Because of the loss of blood, clients with ulcerative colitis commonly have decreased hemoglobin and hematocrit levels. Clients with ulcerative colitis have bloody diarrhea, not steatorrhea (fatty, frothy, foul-smelling stools).

A client with acute ulcerative colitis requests a snack. Which is the most appropriate snack for this client?

A. Carrots and ranch dip

B. Whole-grain cereal and milk

C. A cup of popcorn and a cola drink

D. Applesauce and a graham cracker

D

The diet for the client with ulcerative colitis should be low fiber (low residue). The nurse should avoid providing foods such as whole-wheat grains, nuts, and fresh fruits or vegetables. Typically, lactose-containing foods also are poorly tolerated. The client also should avoid caffeine, pepper, and alcohol.

The nurse is providing instructions to a client with a colostomy about measures to reduce the odor from the colostomy. Which client statement indicates that the educational session was effective?

A. "I should be sure to eat at least 1 cucumber every day."

B. "Beet greens, parsley, or yogurt will help to control the colostomy odor."

C. "I will need to increase my egg intake and try to eat ½ to 1 egg per day."

D. "Green vegetables such as spinach and broccoli will prevent odor, and I should eat these foods every day."

B

The client should be taught to include deodorizing foods in the diet, such as beet greens, parsley, buttermilk, and yogurt. Spinach also may reduce odor, but it is a gas-forming food and should be avoided. Cucumbers, eggs, and broccoli also are gas-forming foods and should be avoided or limited by the client.

The nurse has provided dietary instructions to a client with a diagnosis of peptic ulcer disease. Which client statement indicates that education was effective?

A. "Baked foods such as chicken or fish are all right to eat."

B. "Citrus fruits and raw vegetables need to be included in my daily diet."

C. "I can drink beer as long as I consume only a moderate amount each day."

D. "I can drink coffee or tea as long as I limit the amount to 2 cups daily."

A

Dietary modifications for the client with peptic ulcer disease include eliminating foods that can cause irritation to the gastrointestinal (GI) tract. Items that should be eliminated or avoided include highly spiced foods, alcohol, caffeine, chocolate, and citrus fruits. Other foods may be taken according to the client's level of tolerance for that food.

The nurse is giving dietary instructions to a client who has a new colostomy. The nurse should encourage the client to eat foods representing which diet for the first 4 to 6 weeks postoperatively?

A. Low fiber

B. Low calorie

C. High protein

D. High carbohydrate

A

For the first 4 to 6 weeks after colostomy formation, the client should consume a low-fiber diet. After this period, the client should eat a high-carbohydrate, high-protein diet. The client also is instructed to add new foods, including those with fiber, one at a time to determine tolerance to that food.

A client arrives at the hospital emergency department complaining of acute right lower quadrant abdominal pain, and appendicitis is suspected. Laboratory tests are performed, and the nurse notes that the client's white blood cell (WBC) count is elevated. On the basis of these findings, the nurse should question which health care provider (HCP) prescription documented in the client's medical record?

A. Apply a cold pack to the abdomen.

B. Administer 30 mL of milk of magnesia (MOM).

C. Maintain nothing by mouth (nil per os [NPO]) status.

D. Initiate an intravenous (IV) line for the administration of IV fluids.

B

Appendicitis should be suspected in a client with an elevated WBC count complaining of acute right lower abdominal quadrant pain. Laxatives are never prescribed because if appendicitis is present, the effect of the laxative may cause a rupture with resultant peritonitis. Cold packs may be prescribed for comfort. The client would be NPO and given IV fluids in preparation for possible surgery.

The nurse is providing dietary instructions to a client with a diagnosis of irritable bowel syndrome. The nurse determines that education was effective if the client states the need to avoid which food?

A. Rice

B. Corn

C. Broiled chicken

D. Cream of wheat

B

The client with irritable bowel should take in a diet that consists of 30 to 40 g of fiber daily because dietary fiber will help produce bulky, soft stools and establish regular bowel habits. The client should also drink 8 to 10 glasses of fluid daily and chew food slowly to promote normal bowel function. Foods that are irritating to the intestines need to be avoided. Corn is high in fiber but can be very irritating to the intestines and should be avoided. The food items in the other options are acceptable to eat.

Diphenoxylate hydrochloride with atropine sulfate is prescribed for a client with ulcerative colitis. The nurse should monitor the client for which therapeutic effect of this medication?

A. Decreased diarrhea

B. Decreased cramping

C. Improved intestinal tone

D. Elimination of peristalsis

A

Diphenoxylate hydrochloride with atropine sulfate is an antidiarrheal product that decreases the frequency of defecation, usually by reducing the volume of liquid in the stools. The remaining options are not associated therapeutic effects of this medication.

Sulfasalazine is prescribed for a client with a diagnosis of ulcerative colitis, and the nurse instructs the client about the medication. Which statement made by the client indicates a need for further teaching?

A. "The medication will cause constipation."

B. "I need to take the medication with meals."

C. "I may have increased sensitivity to sunlight."

D. "This medication should be taken as prescribed."

A

Sulfasalazine is an antiinflammatory sulfonamide. Constipation is not associated with this medication. It can cause photosensitivity, and the client should be instructed to avoid sun and ultraviolet light. It should be administered with meals, if possible, to prolong intestinal passage. The client needs to take the medication as prescribed and continue the full course of treatment even if symptoms are relieved.

A client who has been advanced to a solid diet after undergoing a subtotal gastrectomy. What is the appropriate nursing intervention in preventing dumping syndrome?

A. Remove fluids from the meal tray.

B. Give the client 2 large meals per day.

C. Ask the client to sit up for 1 hour after eating.

D. Provide concentrated, high-carbohydrate foods.

A

Factors to minimize dumping syndrome after gastric surgery include having the client lie down for at least 30 minutes after eating; giving small, frequent meals; having the client maintain a low Fowler's position while eating, if possible; avoiding liquids with meals; and avoiding high-carbohydrate food sources. Antispasmodic medications also are prescribed as needed to delay gastric emptying.

The nurse is caring for a client with gastroesophageal reflux disease (GERD) and provides client education on measures to decrease GERD. Which statement made by the client indicates a need for further teaching?

A. "I plan to eat 4 to 6 small meals a day."

B. "I should sleep in the right side-lying position."

C."I plan to have a snack 1 hour before going to bed."

D. "I will stop having a glass of wine each evening with dinner."

C

The control of GERD involves lifestyle changes to promote health and control reflux. These include eating 4 to 6 small meals a day; avoiding alcohol and smoking; sleeping in the right side-lying position to promote oxygenation and frequent swallowing to clear the esophagus; and avoiding eating at least 3 hours before going to bed because reflux episodes are most damaging at night.

A client is readmitted to the hospital with dehydration after surgery for creation of an ileostomy. The nurse assesses that the client has lost 3 lb of weight, has poor skin turgor, and has concentrated urine. The nurse interprets the client's clinical picture as correlating most closely with recent intake of which medication, which is contraindicated for the ileostomy client?

A. Folate

B. Biscodyl

C. Ferrous sulfate

D. Cyanocobalamin

B

The client with an ileostomy is prone to dehydration because of the location of the ostomy in the gastrointestinal tract and should not take laxatives. Laxatives will compound the potential risk for the client. These clients are at risk for deficiencies of folate, iron, and cyanocobalamin and should receive them as supplements if necessary.

The nurse is caring for a client prescribed enteral feeding via a newly inserted nasogastric (NG) tube. Before initiating the enteral feeding, the nurse should perform which action first?

A. Warm the feeding to 103°F (39.4°C).

B. Confirm NG placement by x-ray study.

C. Make sure the continuous enteral feeding tubing is primed.

D. Position the head of the client's bed to 30 degrees or greater.

B

Before initiating enteral feedings via a newly inserted NG tube, the placement of the tube is confirmed by x-ray. If the tube is not in the stomach, the client is at risk for aspiration. Formulas are administered at room temperature, not at 103°F. To prevent aspiration while administering a tube feeding, the nurse should place the client in an upright sitting position or elevate the head of the bed at least 30 degrees. Although an important action, it is not the priority. Priming the enteral feeding tube is important prior to initiating the feedings; however, it is not the priority action.

A client has a large, deep duodenal ulcer diagnosed by endoscopy. Which sign or symptom indicative of a complication should the nurse look for during the client's postprocedure assessment?

A. Bradycardia

B. Nausea and vomiting

C. Numbness in the legs

D. A rigid, boardlike abdomen

D

The client with a large, deep duodenal ulcer is at risk for perforation of the ulcer. If this occurs, the client will experience sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which then becomes rigid and boardlike. Tachycardia, not bradycardia, may occur as hypovolemic shock develops. Nausea and vomiting may not occur if the pyloric sphincter is intact. Numbness in the legs is not an associated finding.

A client with gastritis asks the nurse at a screening clinic about analgesics that will not cause epigastric distress. The nurse should tell the client that which medication is unlikely to cause epigastric distress?

A. Ibuprofen

B. Indomethacin

C. Acetaminophen

D. Naproxen sodium

C

Analgesics, such as acetaminophen, are unlikely to cause epigastric distress. Ibuprofen, indomethacin, and naproxen sodium are nonsteroidal antiinflammatory medications (NSAIDs) and are irritating to the gastrointestinal tract, so they should be avoided in clients with gastritis.

A client is scheduled for an upper gastrointestinal (GI) endoscopy. Which assessment is essential to include in the plan of care following the procedure?

A. Assessing pulses

B. Monitoring urine output

C. Monitoring for rectal bleeding

D. Assessing for the presence of the gag reflex

D

Following the procedure, the client remains NPO (nothing by mouth) until the gag reflex returns, which is usually in 1 to 2 hours. The remaining options are not specific assessments related to this procedure.

A client with a gastric ulcer is prescribed both magnesium hydroxide and cimetidine twice daily. How should the nurse schedule the medications for administration?

A. Drink 8 ounces of water between taking each medication.

B. Administer the cimetidine and magnesium hydroxide at the same time twice daily.

C. Administer each dose of cimetidine 1 hour prior to the administration of magnesium hydroxide.

D. Collaborate with the health care provider (HCP), as the client should not be receiving both medications.

C

The nurse is reviewing the medication record of a client with acute gastritis. Which medication, if noted on the client's record, should the nurse question?

A. Digoxin

B. Furosemide

C. Indomethacin

D. Propranolol hydrochloride

C

Indomethacin is a nonsteroidal antiinflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Digoxin is a cardiac medication. Furosemide is a loop diuretic. Propranolol hydrochloride is a beta-adrenergic blocking agent. Digoxin, furosemide, and propranolol are not contraindicated in clients with gastric disorders.

The nurse is caring for a hospitalized client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, should the nurse report to the health care provider (HCP)?

A. Hypotension

B. Bloody diarrhea

C. Rebound tenderness

D. A hemoglobin level of 12 mg/dL (120 mmol/L)

C

Rebound tenderness may indicate peritonitis. Bloody diarrhea is expected to occur in ulcerative colitis. Because of the blood loss, the client may be hypotensive and the hemoglobin level may be lower than normal. Signs of peritonitis must be reported to the HCP.

A client with Crohn's disease is experiencing acute pain, and the nurse provides information about measures to alleviate the pain. Which statement by the client indicates the need for further teaching?

A. "I know I can massage my abdomen."

B. "I will continue using antispasmodic medication."

C. "One of the best things I can do is use relaxation techniques."

D. "The best position for me is to lie supine with my legs straight."

D

Pain associated with Crohn's disease is alleviated by the use of analgesics and antispasmodics and also by practicing relaxation techniques, applying local cold or heat to the abdomen, massaging the abdomen, and lying with the legs flexed. Lying with the legs extended is not useful because it increases the muscle tension in the abdomen, which could aggravate inflamed intestinal tissues as the abdominal muscles are stretched.

The nurse is caring for a client experiencing an exacerbation of Crohn's disease. Which intervention should the nurse anticipate the health care provider prescribing?

A. Enteral feedings

B. Fluid restrictions

C. Oral corticosteroids

D. Activity restrictions

C

Crohn's disease is a form of inflammatory bowel disease that is a chronic inflammation of the gastrointestinal (GI) tract. It is characterized by periods of remission interspersed with periods of exacerbation. Oral corticosteroids are used to treat the inflammation of Crohn's disease, so option 3 is the correct one. In addition to treating the GI inflammation of Crohn's disease with medications, it is also treated by resting the bowel. Therefore, option 1 is incorrect. Option 2 is incorrect, as clients with Crohn's disease typically have diarrhea and would not be on fluid restrictions. Option 4, activity restrictions, is not indicated. The client can do activities as tolerated but should avoid stress and strain.

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted?

A. Decreased blood pressure

B. Absence of muscle tremors

C. Relief of nausea and vomiting

D. No further episodes of diarrhea

C

Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential adverse effect?

A. Tremors

B. Constipation

C. Double vision

D. Numbness in fingers and toes

A

Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved?

A. Nausea

B. Belching

C. Epigastric pain

D. Difficulty swallowing

C

Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not indicated for nausea, belching, and dysphagia.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate?

A. Providing IV fluids and inserting a nasogastric (NG) tube

B. Administering oral bicarbonate and testing the patient's gastric pH level

C. Performing a fecal occult blood test and administering IV calcium gluconate

D. Starting parenteral nutrition and placing the patient in a high-Fowler's position

A

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate?A. Providing IV fluids and inserting a nasogastric (NG) tubeB. Administering oral bicarbonate and testing the patient's gastric pH levelC. Performing a fecal occult blood test and administering IV calcium gluconateD. Starting parenteral nutrition and placing the patient in a high-Fowler's position

The patient with chronic gastritis is being put on a combination of medications to eradicate H. pylori. Which drugs does the nurse know will probably be used for this patient?

A. Antibiotic(s), antacid, and corticosteroid

B. Antibiotic(s), aspirin, and antiulcer/protectant

C. Antibiotic(s), proton pump inhibitor, and bismuth

D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)

C

To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

The nurse would question the use of which cathartic agent in a patient with renal insufficiency?

A. Bisacodyl (Dulcolax)

B. Lubiprostone (Amitiza)

C. Cascara sagrada (Senekot)

D. Magnesium hydroxide (Milk of Magnesia)

D

Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid epigastric area along with a rigid, board-like abdomen. These clinical manifestations most likely indicate which of the following?

a. An intestinal obstruction has developed

b. Additional ulcers have developed

c. The esophagus has become inflamed

d. The ulcer has perforated

D

A client has been taking aluminum hydroxide 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation?

a. The client has not been including enough fiber in his diet

b. The client needs to increase his daily exercise

c. The client is experiencing a side effect of the aluminum hydroxide.

d. The client has developed a gastrointestinal obstruction

C

It is most likely that the client is experiencing a side effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of bowel obstruction.

The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves:

a. Cutting the vagus nerve

b. Removing the distal portion of the stomach

c. Removal of the ulcer and a large portion of the cells that produce hydrochloric acid

d. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum

D

Which of the following best describes the method of action of medications, such as ranitidine (Zantac), which are used in the treatment of peptic ulcer disease?

a. Neutralize acid

b. Reduce acid secretions

c. Stimulate gastrin release

d. Protect the mucosal barrier

B

If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client?

a. Blood replacement

b. Antacid administration

c. Nasogastric tube suction

d. Fluid and electrolyte replacement

B

The nurse explains to the patient with gastroesophageal reflux disease that this disorder:

A. results in acid erosion and ulceration of the esophagus caused by frequent vomiting,

B. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms,

C. is the protrusion of a portion of the stomach into to esophagus through an opening in the diaphragm,

D. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the espophagus

D. The acidic contents of the stomach touching the inside of the esophagus are responsible for the physical sensation known as "heart-burn" that is a cardinal symptom of GERD

"Which of the following types of gastritis is

associated with Helicobacter pylori and duodenal ulcers?

1. Erosive (hemorrhagic) gastritis

2. Fundic gland gastritis (type A)

3. Antral gland gastritis (type B)

4.Aspiring-induced gastric ulcer

3 - Erosive (hemorrhagic) gastritis can be

caused by ingestion of substances that irritate the gastric mucosa. Fundic gland gastritis (type A) is associated with diffuse severe mucosal atrophy and the presence of pernicious anemia. Antral gland gastritis (type B) is the most common form of gastritis, and is associated with Helicobacter pylori and duodenal ulcers

The client with a hiatal hernia chronically experiences heartburn following meals. The nurse plans to teach the client to avoid which action because it is contraindicated with hiatal hernia?

1. Lying recumbent following meals

2. Taking in small, frequent, bland meals

3. Raising the head of the bed on 6-inch blocks

4. Taking H2-receptor antagonist medication

Correct answer: 1

Laying recumbant following meals or at night will cause reflux and pain. Relief is usually achieved with the intake of small, bland meals, use of H2 receptor antagonists and antacids, and elevation of the thorax after meals and during sleep

Which of the following types of gastritis ic associated with Helicobacter pylori and duodenal ulcers?

1. Erosive (hemorrhagic) gastritis

2. Fundic gland gastritis (type A)

3. Antral gland gastritis (type B)

4. Aspiring-induced gastric ulcer

Correct answer: 3. Antral gland gastritis ( type B). Rationale: Antral gland gastritis is the most common form of gastritis and is associated with Helicobacter pylori and duodenal ulcers

A patient has a vagotomy with antrectomy to treat a duodenal ulcer. Postoperatively, the patient develops dumping syndrome. Which of the following statements, if made by the patient, should indicate to the nurse that further dietary teaching is needed?

1. I should eat bread with each meal

2. I should eat smaller meals more frequently.

3. I should lie down after eating.

4. I should avoid drinking fluids with my meals

Answer 1, Patient should decrease intake of carbohydrates

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis?

A. You'll need to drink at least two to three glasses of milk daily.

B."It would likely be beneficial for you to eliminate drinking alcohol."

C. Many people find that a minced or pureed diet eases their symptoms of PUD.

D. Your medications should allow you to maintain your present diet while minimizing symptoms

CORRECT ANSWER: B Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD and alcohol is best avoided because it can delay healing

Which of the following drugs is a histamine blocker and reduces levels of gastric acid?

A. Omeprazole (Prilosec)

B. Metoclopramide (Reglan)

C. Cimetidine (Tagamet)

D. Magnesium Hydroxide (Maalox)

Answer C, Cimetidine bind to H2 in the tissue and decreases the production of gastric acid

which is the most common upper GI problem?

1. peptic ulcer disease

2. Crohns

3. Gerd

4. ulcerative colitis

Answer 3, Gerd is the only upper GI problem

The nurse determines that a patient has experienced the beneficial effects of medication therapy with famotidine (Pepcid) when which of the following symptoms is relieved?

A) Nausea

B) Belching

C) Epigastric pain

D) Difficulty swallowing

Answer C, "Famotidine is an H2-receptor antagonist that inhibits parietal cell

output of HCl acid and minimizes damage to gastric mucosa related to

hyperacidity, thus relieving epigastric pain

Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)?

1. Limit caffeine intake to two cups of coffee per day

2. Do not lie down for 2 hours after eating

3. Follow a low-protein diet

4. Take medications with milk to decrease irritation

2. The nurse should instruct the client to not lie down for about 2 hours after eating to prevent reflux.

The client is scheduled to have an upper GI tract series of x-rays. Following the x-rays, the nurse should instruct the client to:

1. Take a laxative

2. follow a clear liquid diet

3. Administer an enema

4. Take an antiemetic

1. The client should take a laxative after an upper GI series to stimulate a bowel movement. This examination involves the administration of barium, which must be promptly eliminated from the body because it may harden and cause an obstruction.

A client who has been diagnosed with GERD has heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet?

1. Lean beef

2. Air-popped popcorn

3. Hot chocolate

4. Raw vegetables

3. With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol.

The client with GERD has a chronic cough. This symptom may be indicative of which of the following?

1. Development of laryngeal cancer

2. Irritation of the esophagus

3. Esophageal scar tissue formation

4. Aspiration of gastric contents

4. Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents.

Bethanechol (Urecholine) has been prescribed for a client with GERD. The nurse should assess the client for which of the following adverse effects?

1. Constipation

2. Urinary urgency

3. Hypertension

4. Dry oral mucosa

2. This is a cholinergic drug that may be used in GERD to increase lower esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation.

The client attends two sessions with the dietitian to learn about diet modifications to minimize GERD. The teaching would be considered successful if the client decreases the intake of which of the following foods?

1. fats

2. high-sodium foods

3. Carbohydrates

4. high calcium foods

1. Fats are associated with decreased esophageal sphincter tone.

Which of the following dietary measures would be useful in preventing Esophageal reflux?

1. Eating small, frequent meals

2. increasing fluid intake

3. avoiding air swallowing with meals

4. Adding a bedtime snack to the dietary plan

1. Esophageal reflux worsens when the stomach is over-distended with food. Therefore, an important measure is to eat small,frequent meals.

The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which of the following symptoms?

1. Heartburn

2. Jaundice

3. Anorexia

4. Stomatitis

1. Heartburn, the most common symptom of a sliding hiatal hernia , results from reflux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms.

Which of the following factors would most likely contribute to the development of a client's hiatal hernia?

1. having a sedentary desk job

2. being 5 feet, 3 inches tall and weighing 190 lbs

3. using laxatives frequently

4. being 40 years old

2. Any factor that increases intra-abdominal pressure, such as obesity, can contribute to the development of hiatal hernia. Other factors include abdominal straining, frequent heavy lifting, and pregnancy. Hiatal hernia is also associated with older age and occurs in women more frequently than in men.

Which of the following nursing interventions would most likely promote self-care behaviors in the client with a hiatal hernia?

1. Introduce the client to other people who are successfully managing their care.

2. Include the client's daughter in the teaching so that she can help implement the plan

3. Ask the client to identify other situation in which the client changed health care habits

4. Provide reassurance that the client will be able to implement all aspects of the plan successfully.

3. self-responsibility is the key to individual health maintenance. Using examples of situation in which the client has demonstrated self-responsibility can be reinforcing and supporting. The client has ultimate responsibility for personal health habits.

The client has been taking magnesium hydroxide (milk of magnesia) to control hiatal hernia symptoms. The nurse should assess the client for which of the following conditions most commonly associated with the ongoing use of magnesium based antacids?

1. anorexia

2. weight gain

3. diarrhea

4. constipation

3. The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea.

Which of the following lifestyle modifications should the nurse encourage the client with hiatal hernia to include in ADLs?

1. Daily aerobic exercise

2. eliminating smoking and alcohol use

3. balancing activity and rest

4. avoiding high-stress situation

2. Smoking and alcohol use both reduce esophageal sphincter tone and can result in reflux. They therefore should be avoided by clients with hiatal hernia.

In developing a teaching plan for the client with a hiatal hernia, the nurses assessment of which work-related factors would be most useful?

1. number and length of breaks

2. body mechanics used in lifting

3. temperature in the work area

4. Cleansing solvents used

2. Bending, especially after eating, can cause GERD. Lifting heavy objects increases intra-abdominal pressure. Assessing the client's lifting techniques enables the nurse to evaluate the client's knowledge of factors contributing to hiatal hernia and how to prevent complications.

The nurse instructs the client on health maintenance activities to help control symptoms from a hiatal hernia. Which of the following statements would indicate that the client has understood the instructions?

1. "I'll avoid lying down after a meal."

2. "I can still enjoy my potato chips and cola at bedtime."

3. "I wish I didn't have to give up swimming."

4. "If I wear a girdle, I'll have more support for my stomach."

1. A client with a hiatal hernia should avoid the recumbent position immediately after meals to minimize gastric reflux. Bedtime snacks, as well as high fat foods and carbonated beverages should be avoided.

The physician prescribes metoclopramide hyrochloide (Reglan) for the client with a hiatal hernia. This drug is used in hiatal hernia therapy to accomplish which of the following objectives?

1. Increase tone of the esophageal sphincter

2. Neutralize gastric secretions

3. delay gastric emptying

4. reduce secretion of digestive juices

1. This medicaiton increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of reflux.

The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride (Reglan)?

1. Antacids

2. Antihypertensives

3. Anticoagulants

4. Alcohol

4. This drug can cause sedation. Alcohol and other CNS depressants add to this sedation. A client taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug.

A client is taking cemetidine (Tagament) to treat a hiatal herna. The nurse should evaluate the client to determine that the drug has been effective in preventing which of the following?

1. esophageal reflux

2. dysphagia

3. esophagitis

4. ulcer formation

A histamine receptor blocker that decreases the quantity of gastric secretions. It may be used in hiatal hernia therapy to prevent or treat the esophagitis and heartburn associated with reflux.

The client asks the nurse if surgery is needed to correct a hiatal hernia. Which reply by the nurse would be the MOST accurate?

1. "Surgery is usually required, although medical treatment is attempted first."

2. "Hiatal hernia symptoms can usually be successfully managed with diet modification, medications, and lifestyle changes."

3. "Surgery is not performed for this type of hernia."

4. "A minor surgical procedure to reduce the size of the diaphragmatic opening will probably be planned."

2. Most clients can be treated successfully with a combination of diet restrictions, medications, weight control, and lifestyle modifications. Surgery is performed only when these attempts fail.

A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms reported by the patient may indicate the patient has GERD? SELECT-ALL-THAT-APPLY:

A. Bitter taste in mouth

B. Dry cough

C. Melena

D. Difficulty swallowing

E. Smooth, red tongue

F. Murphy's Sign

ABD

Your patient, who is presenting with signs and symptoms of GERD, is scheduled to have a test that assesses the function of the esophagus' ability to squeeze food down into the stomach and the closer of the lower esophageal sphincter. The patient asks you, "What is the name of the test I'm having later today?" You tell the patient the name of the test is:

A. Lower Esophageal Gastrointestinal Series

B. Transesophageal echocardiogram

C. Esophageal manometry

D. Esophageal pH monitoring

C

After dinner time, during hourly rounding, a patient awakes to report they feel like "food is coming up" in the back of their throat and that there is a bitter taste in their mouth. What nursing intervention will you perform next?

A. Perform deep suctioning

B. Assist the patient into the Semi-Fowler's position

C. Keep the patient NPO

D. Instruct the patient to avoid milk products

B

During a home health visit, you are helping a patient develop a list of foods they should avoid due to GERD. Which items in the patient's pantry should be avoided? SELECT-ALL-THAT-APPLY:

A. Hot and Spicy Pork Rinds

B. Peppermint Patties

C. Green Beans

D. Tomato Soup

E. Chocolate Fondue

F. Almonds

G. Oranges

ABDEG

After providing education to a patient with GERD. You ask the patient to list 4 things they can do to prevent or alleviate signs and symptoms of GERD. Which statement is INCORRECT?

A. "It is best to try to consume small meals throughout the day than eat 3 large ones."

B. "I'm disappointed that I will have to limit my intake of peppermint and spearmint because I love eating those types of hard candies."

C. "It is important I avoid eating right before bedtime."

D. "I will try to lie down after eating a meal to help decrease pressure on the lower esophageal sphincter."

D

You're collecting a patient's medication history that has GERD. Which medication below is NOT typically used to treat GERD?

A. Colesevelam "Welchol"

B. Omeprazole "Prilosec"

C. Metoclopramide "Reglan"

D. Ranitidine HCL "Zantac"

A

A patient is taking Bethanechol "Urecholine" for treatment of GERD. This is known as what type of drug?

A. Proton-pump inhibitor

B. Histamine receptor blocker

C. Prokinetic

D. Mucosal Healing Agent

C

Which of the following does NOT play a role in the development of GERD?

A. Pregnancy

B. Hiatal hernia

C. Usage of antihistamines or calcium channel blockers

D. All the above play a role in GERD

D

The nurse has been assigned to provide care for four clients at the beginning of the day shift. In what order should the nurse assess these clients?

1. The client awaiting hiatal hernia repair at 11 am.

2. A client with suspected gastric cancer who is on nothing-by-mouth (NPO) status for tests.

3. A client with peptic ulcer disease experiencing sudden onset of acute stomach pain.

4. A client who is requesting pain medication 2 days after surgery to repair a fractured jaw.

3, 4, 2, 1

The client with peptic ulcer disease who is experiencing a sudden onset of acute stomach pain should be assessed first by the nurse. The sudden onset of stomach pain could be indicative of a perforated ulcer, which would require immediate medical attention. It is also important for the nurse to thoroughly assess the nature of the client's pain. The client with the fractured jaw is experiencing pain and should be assessed next. The nurse should then assess the client who is NPO for tests to ensure NPO status and comfort. Last, the nurse can assess the client before surgery.

The nurse is caring for a client who has just had an upper GI endoscopy. The client's vital signs must be taken every 30 minutes for 2 hours after the procedure. The nurse assigns an unlicensed nursing personnel (UAP) to take the vital signs. One hour later, the UAP reports the client, who was previously afebrile, has developed a temperature of 101.8 ° F (38.8 ° C). What should the nurse do in response to this reported assessment data?

1. Promptly assess the client for potential perforation.

2. Tell the assistant to change thermometers and retake the temperature.

3. Plan to give the client acetaminophen (Tylenol) to lower the temperature.

4. Ask the assistant to bathe the client with tepid water.

1.

A sudden spike in temperature following an endoscopic procedure may indicate perforation of the GI tract. The nurse should promptly conduct a further assessment of the client, looking for further indicators of perforation, such as a sudden onset of acute upper abdominal pain; a rigid, boardlike abdomen; and developing signs of shock. Telling the assistant to change thermometers is not an appropriate action and only further delays the appropriate action of assessing the client. The nurse would not administer acetaminophen without further assessment of the client or without a physician's order; a suspected perforation would require that the client be placed on nothing-by-mouth status. Asking the assistant to bathe the client before any assessment by the nurse is inappropriate.

A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric region along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following?

1. An intestinal obstruction has developed.

2. Additional ulcers have developed.

3. The esophagus has become inflamed.

4. The ulcer has perforated.

4.

The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. The development of additional ulcers or esophageal inflammation would not cause a rigid, boardlike abdomen.

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect to assess? Select all that apply.

1. Epigastric pain at night.

2. Relief of epigastric pain after eating.

3. Vomiting.

4. Weight loss.

5. Melena.

3, 4, 5.

Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.

The nurse is caring for a client who has had a gastroscopy. Which of the following signs and symptoms may indicate that the client is developing a complication related to the procedure? Select all that apply.

1. The client has a sore throat.

2. The client has a temperature of 100 ° F (37.8 ° C).

3. The client appears drowsy following the procedure.

4. The client has epigastric pain.

5. The client experiences hematemesis.

2, 4, 5.

Following a gastroscopy, the nurse should monitor the client for complications, which include perforation and the potential for aspiration. An elevated temperature, complaints of epigastric pain, or the vomiting of blood (hematemesis) are all indications of a possible perforation and should be reported promptly. A sore throat is a common occurrence following a gastroscopy. Clients are usually sedated to decrease anxiety and the nurse would anticipate that the client will be drowsy following the procedure.

A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client?

1. Ineffective coping related to fear of diagnosis of chronic illness.

2. Deficient knowledge related to unfamiliarity with significant signs and symptoms.

3. Constipation related to decreased gastric motility.

4. Imbalanced nutrition: Less than body requirements related to gastric bleeding.

2.

Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stool causes it to be black. The odor of the stool is very offensive. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their primary health care provider. The data do not support the other diagnoses.

A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug?

1. Heal the ulcer.

2. Protect the ulcer surface from acids.

3. Reduce acid concentration.

4. Limit gastric acid secretion.

4.

Histamine-2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretory, or proton-pump inhibitors, such as omeprazole (Prilosec), help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate (Carafate), protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.

A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night. The nurse should instruct the client to do which activities? Select all that apply.

1. Obtain adequate rest to reduce stimulation.

2. Eat small, frequent meals throughout the day.

3. Take all medications on time as ordered.

4. Sit up for one hour when awakened at night.

5. Stay away from crowded areas.

1, 2, 3, 4.

The nurse should encourage the client to reduce stimulation that may enhance gastric secretion. The nurse can also advise the client to utilize health practices that will prevent recurrences of ulcer pain, such as avoiding fatigue and elimination of smoking. Eating small, frequent meals helps to prevent gastric distention if not actively bleeding and decreases distension and release of gastrin. Medications should be administered promptly to maintain optimum levels. After awakening during the night, the client should eat a small snack and return to bed, keeping the head of the bed elevated for an hour after eating. It is not necessary to stay away from crowded areas.

A client with peptic ulcer disease reports that he has been nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply.

1. Administering an antacid hourly until nausea subsides. 2. Monitoring the client's vital signs.

3. Notifying the physician of the client's symptoms.

4. Initiating oxygen therapy.

5. Reassessing the client in an hour.

2, 3.

The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait 1 hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of which of the following?

1. Bland foods.

2. High-protein foods.

3. Any foods that are tolerated.

4. Large amounts of milk.

3.

Diet therapy for ulcer disease is a controversial issue. There is no scientific evidence that diet therapy promotes healing. Most clients are instructed to follow a diet that they can tolerate. There is no need for the client to ingest only a bland or high-protein diet. Milk may be included in the diet, but it is not recommended in excessive amounts.

The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers from his briefcase and arguing on the telephone with a coworker. The nurse's response to observing these actions should be based on knowledge that:

1. Involvement with his job will keep the client from becoming bored.

2. A relaxed environment will promote ulcer healing.

3. Not keeping up with his job will increase the client's stress level.

4. Setting limits on the client's behavior is an important nursing responsibility.

2.

A relaxed environment is an essential component of ulcer healing. Nurses can help clients understand the importance of relaxation and explore with them ways to balance work and family demands to promote healing. Being involved with his work may prevent boredom; however, this client is upset and argumentative. Not keeping up with his job will probably increase the client's stress level, but the nurse's response is best if it is based on the fact that a relaxed environment is an essential component of ulcer healing. Nurses cannot set limits on a client's behavior; clients must make the decision to make lifestyle changes.

A client with a peptic ulcer has been instructed to avoid intense physical activity and stress. Which strategy should the client incorporate into the home care plan?

1. Conduct physical activity in the morning so that he can rest in the afternoon.

2. Have the family agree to perform the necessary yard work at home.

3. Give up jogging and substitute a less demanding hobby.

4. Incorporate periods of physical and mental rest in his daily schedule.

4.

It would be most effective for the client to develop a health maintenance plan that incorporates regular periods of physical and mental rest in the daily schedule. Strategies should be identified to deal with the types of physical and mental stressors that the client needs to cope with in the home and work environments. Scheduling physical activity to occur only in the morning would not be restful or practical. There is no need for the client to avoid yard work or jogging if these activities are not stressful.

A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times?

1. Before meals.

2. With meals.

3. At bedtime.

4. When pain occurs.

3.

Ranitidine blocks secretion of hydrochloric acid. Clients who take only one daily dose of ranitidine are usually advised to take it at bedtime to inhibit nocturnal secretion of acid. Clients who take the drug twice a day are advised to take it in the morning and at bedtime. It is not necessary to take the drug before meals. The client should take the drug regularly, not just when pain occurs.

A client has been taking aluminum hydroxide (Amphojel) 30 mL six times per day at home to treat his peptic ulcer. He tells the nurse that he has been unable to have a bowel movement for 3 days. Based on this information, the nurse would determine that which of the following is the most likely cause of the client's constipation?

1. The client has not been including enough fiber in his diet.

2. The client needs to increase his daily exercise.

3. The client is experiencing an adverse effect of the aluminum hydroxide.

4. The client has developed a gastrointestinal obstruction.

3.

It is most likely that the client is experiencing an adverse effect of the antacid. Antacids with aluminum salt products, such as aluminum hydroxide, form insoluble salts in the body. These precipitate and accumulate in the intestines, causing constipation. Increasing dietary fiber intake or daily exercise may be a beneficial lifestyle change for the client but is not likely to relieve the constipation caused by the aluminum hydroxide. Constipation, in isolation from other symptoms, is not a sign of a bowel obstruction.

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid?

1. "I should take my antacid before I take my other medications."

2. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid."

3. "My antacid will be most effective if I take it whenever I experience stomach pains."

4. "It is best for me to take my antacid 1 to 3 hours after meals."

4.

Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids. If antacids are taken more frequently than recommended, the likelihood of developing adverse effects increases. Therefore, the client should not take antacids as often as desired to control pain.