Question 1

The nurse administers alternating doses of two antacids into the NG tube of a client with a duodenal ulcer. The finding that best indicates that this drug regimen has been successful is
A) absent NG tube drainage.
B) decreased abdominal rigidity.
C) increased gastric pH.mild diarrhea.
D) mild diarrhea.

Accepted Answer

Antacids increase gastric pH to reduce pepsin activity. Antacids would not affect NG tube drainage. Abdominal rigidity is not a sign of duodenal ulcers. Mild diarrhea might occur as a side effect of antacid administration.

Question 2

The nurse planning to irrigate a nasogastric (NG) tube prepares to use
A) half-strength peroxide.
B) normal saline.
C) sterile water.
D) tap water.

Accepted Answer

Normal saline is the preferred irrigating solution because water, a hypotonic solution, increases electrolyte loss through osmotic action if the tube is irrigated frequently.

Question 3

An older male client with chronic gastritis asks the nurse, "Do you think I'll get gastric cancer?" The most accurate response by the nurse is
A) "As long as the chronic gastritis is diagnosed early, there is little risk of gastric cancer."
B) "Chronic gastritis is not associated with the development of gastric cancer in men over 40."
C) "Individual predictions are not possible, but chronic gastritis is associated with the development of gastric cancer."
D) "Women with chronic gastritis are more likely to get gastric cancer than men who have chronic gastritis."

Accepted Answer

Chronic gastritis usually heals without scarring but can cause hemorrhage and ulcer formation. The atrophic changes eventually result in minimal amounts of acid being secreted into the stomach (achlorhydria), which is a major risk factor for development of gastric cancer.

Question 4

A nurse is instructing a client with a peptic ulcer on recommended dietary changes. A goal of teaching has been met when the client states that he/she will avoid which of the following beverages?
A) Apple juice
B) Lemonade
C) Milk
D) Water

Accepted Answer

Foods known to increase gastric acidity or cause discomfort should be avoided, such as coffee, alcohol, and milk. Patients should self-limit any other foods that cause them distress.

Question 5

A client is taking cortisone. The nurse schedules the medication with food because cortisone can have which effect on gastric mucosa when given on an empty stomach? Cortisone will cause
A) dramatically increased gastric pH.
B) increased amount of GI secretions.
C) increased transit time of GI contents.
D) susceptibility of the mucosa to injury.

Accepted Answer

Anti-inflammatory agents may stimulate acid production, cause local mucosal damage, and suppress mucus secretion.

Question 6

A client with acute gastritis is admitted to the emergency department for GI bleeding. The nurse would anticipate the client's history will include
A) alcohol abuse.
B) anorexia.
C) high-carbohydrate, high-fat diet.
D) recent use of oral penicillin.

Accepted Answer

Gastritis usually stems from the ingestion of a corrosive, erosive, or infectious substance. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), digitalis, chemotherapeutic drugs, steroids, acute alcoholism, and food poisoning (typically caused by Staphylococcus organisms) are common causes.

Question 7

The nurse is monitoring a client who has had gastric surgery for manifestations of dumping syndrome. The nurse should be particularly watchful for the early manifestation of
A) hypertension.
B) pain.
C) tenesmus.
D) vertigo.

Accepted Answer

Early manifestations of dumping syndrome, which occur 5 to30 minutes after eating, involve the vasomotor disturbances of vertigo, tachycardia, syncope, sweating, pallor, palpitation, diarrhea, and nausea, with the urge to lie down. None of the other three choices are early manifestations of dumping syndrome.

Question 8

The client with chronic gastritis is experiencing abdominal pain. In order to provide the client the fastest relief, the nurse plans to administer
A) aluminum hydroxide with magnesium trisilicate (Gaviscon).
B) clarithromycin (Biaxin).
C) metronidazole (Flagyl).
D) omeprazole (Prilosec).

Accepted Answer

Aluminum hydroxide with magnesium trisilicate (Gaviscon), which produces soothing foam, is the best antacid for gastritis. Biaxin and metronidazole are antibiotics. Omeprazole can be used for gastritis and for the short-term management of peptic ulcer disease but it will not relieve pain as quickly as the coating effect of aluminum hydroxide.

Question 9

The nurse is caring for a client with chronic atrophic gastritis. When taking an admission history, the nurse would anticipate a history of
A) cardiac disease.
B) emphysema.
C) intestinal parasites.
D) pernicious anemia.

Accepted Answer

Atrophic gastritis, which occurs in all layers of the stomach, often develops in association with gastric ulcer and gastric cancer and is invariably associated with pernicious anemia because of the lack of intrinsic factor.

Question 10

A client asks the nurse about the prescribed diet after gastric surgery. The nurse clarifies that a high-protein, high-fat, low-carbohydrate, dry diet is the best choice after gastric surgery because this diet
A) does not cause diarrhea.
B) does not dilate the stomach.
C) is quickly digested.
D) is slow to leave the stomach.

Accepted Answer

The diet is slowly digested and is slow to leave the stomach because of its density and the reduction of fluid with the meal. This reduces the possibility of dumping syndrome.

Question 11

A nurse is assessing a client with a history of a duodenal ulcer. Which finding is consistent with the nurse's knowledge about this condition?
A) Certain types of food increase gastric distress.
B) Eating nearly any food causes pain.
C) Pain may awaken the client in the middle of the night.
D) The client complains of spitting up blood.

Accepted Answer

Clients with duodenal ulcers have pain on an empty stomach or in the middle of the night, and discomfort may be relieved by the ingestion of food or antacids.

Question 12

Priority nursing actions to achieve critical goals in the postoperative period for a client who has just returned from a Billroth II procedure should include
A) encouraging oral intake.
B) ensuring frequent coughing and deep breathing.
C) irrigating the client's NG tube every hour.
D) maintaining the client in the semi-Fowler position.

Accepted Answer

Nurses should thoroughly demonstrate and discuss the importance of deep-breathing exercises or use of an incentive spirometer for any surgical client. Clients should be warned that the high abdominal incision with a Billroth II procedure makes deep breathing very uncomfortable and therefore increases the risk of respiratory complications. This client will be NPO for now and will not be allowed oral intake. Irrigation of a surgically-placed NG tube hourly is not a standard order. In the immediate postoperative period, the client will likely be supine or in a low-Fowler position.

Question 13

Ranitidine (Zantac) is prescribed for a client with a gastric ulcer. The statement that best indicates to the nurse that the client understands the action of this drug is
A) "I will take this medication at bedtime to relieve pain."
B) "Ranitidine will activate protective mucous barriers."
C) "Stomach acids are neutralized by this medication."
D) "This drug reduces the acid in my stomach."

Accepted Answer

H?-receptor antagonists inhibit gastric acid secretions by blocking H? receptors on parietal cells.

Question 14

A client needs insertion of a long tube for intestinal decompression. The tube that is inappropriate for intestinal decompression is the
A) Cantor tube.
B) Harris tube.
C) Miller-Abbott tube.
D) Salem sump tube.

Accepted Answer

Short tubes such as the Salem sump tube are long enough to extend into the stomach but not into the bowel.

Question 15

An important health promotion activity for nurses to teach clients with chronic gastritis is to
A) avoid any spicy or overly-hot food.
B) see the health care provider at regular intervals.
C) stick to a regular exercise plan.
D) take only nonsteroidal anti-inflammatory drugs for mild pain.

Accepted Answer

Most clients with chronic gastritis are managed at home and need to see their health care provider on a regular basis to detect complications. A client with H. pylori and atrophic gastritis is at high risk for gastric cancer, which must be caught early for a positive outcome.

Question 16

Before tube insertion, the nurse performs the NEX measurement, which is the
A) distance from the tip of the nose to the ear lobe and to the xiphoid.
B) length of a tube from the hub to the tip converted to centimeters.
C) distance from the ear lobe to the umbilicus.
D) width of the lumen of the tube multiplied by the length.

Accepted Answer

The NEX is the measurement from the tip of the nose to the ear lobe and to the xiphoid process used to determine the amount of tube needed for entry into the stomach.

Question 17

A nurse is caring for a client with severe burns. The client complains of abdominal pain and begins vomiting blood. The nurse anticipates diagnostic testing to determine if the client has developed
A) a Curling's ulcer.
B) chronic gastritis.
C) H. pylori infection.
D) pyloric stenosis.

Accepted Answer

Besides peptic and gastric ulcers, acute gastric erosion (frequently called stress ulcers or stress-erosive gastritis) can occur after an acute medical crisis. Major assaults that lead to gastroduodenal ulcerations include (a) severe trauma or major illness, (b) severe burns, (c) head injury or intracranial disease, (d) drug ingestion (e.g., aspirin, NSAIDs, alcohol) that acts on the gastric mucosa, (e) shock, and (f) sepsis.

Question 18

A client in the emergency department is hemorrhaging from a peptic ulcer and is being prepared quickly for emergency surgery. The nurse notes that the client is crying and reaches for the nurse frequently. The best response by the nurse to this client is to
A) continue working efficiently to get the client ready for the operating room.
B) make eye contact, touch the client, and say, "This must be very scary for you."
C) send someone to find the chaplain to discuss advance directives.
D) sit by the client and say, "I have some time that I can spend with you."

Accepted Answer

This is an emergency situation, so the nurse must continue to prepare the client for a life-saving operation. However, in this setting, clients may be afraid and the nurse needs to respond in a caring fashion to the nonverbal behavior the client exhibits.

Question 19

The nurse has just finished inserting a nasogastric (NG) tube in a client who has difficulty swallowing. The best measure to test for placement of the tube is
A) asking the client to speak.
B) aspirating gastric contents.
C) inspecting the posterior pharynx for correct placement.
D) placing the end of the tube in a glass of water.

Accepted Answer

To verify tube placement, the nurse can aspirate gastric contents for short tubes, like a nasogastric tube. Other reliable methods for determining placement include measuring the pH of the gastric contents and checking placement with an x-ray if the tube has radiographic markings.

Question 20

A nurse is caring for a patient who had surgery and will be receiving chemotherapy and radiation treatment for stage III gastric cancer. The client is planning several extensive trips after the chemotherapy and radiation are finished. Which statement by the nurse is most appropriate at this time?
A) "Before you leave, be sure your will and other advance directives are up to date."
B) "What does your family think of your travel plans?"
C) "What has the physician told you about your disease and treatment?"
D) "Your trip sounds wonderful! Tell me more about it."

Accepted Answer

The 5-year survival rate for stage III gastric cancer is less than 10%. Chemotherapy and radiation may be palliative measures for this client. The nurse needs to gently find out what the client understands about this condition and the prognosis before being able to guide the client in making appropriate plans.

Quiz 31: Management of Clients with Digestive Disorders

The nurse administers alternating doses of two antacids into the NG tube of a client with a duodenal ulcer. The finding that best indicates that this drug regimen has been successful is

The nurse planning to irrigate a nasogastric (NG) tube prepares to use

An older male client with chronic gastritis asks the nurse, "Do you think I'll get gastric cancer?" The most accurate response by the nurse is

A nurse is instructing a client with a peptic ulcer on recommended dietary changes. A goal of teaching has been met when the client states that he/she will avoid which of the following beverages?

A client is taking cortisone. The nurse schedules the medication with food because cortisone can have which effect on gastric mucosa when given on an empty stomach? Cortisone will cause

A client with acute gastritis is admitted to the emergency department for GI bleeding. The nurse would anticipate the client's history will include

The nurse is monitoring a client who has had gastric surgery for manifestations of dumping syndrome. The nurse should be particularly watchful for the early manifestation of

The client with chronic gastritis is experiencing abdominal pain. In order to provide the client the fastest relief, the nurse plans to administer

The nurse is caring for a client with chronic atrophic gastritis. When taking an admission history, the nurse would anticipate a history of

A client asks the nurse about the prescribed diet after gastric surgery. The nurse clarifies that a high-protein, high-fat, low-carbohydrate, dry diet is the best choice after gastric surgery because this diet

A nurse is assessing a client with a history of a duodenal ulcer. Which finding is consistent with the nurse's knowledge about this condition?

Priority nursing actions to achieve critical goals in the postoperative period for a client who has just returned from a Billroth II procedure should include

Ranitidine (Zantac) is prescribed for a client with a gastric ulcer. The statement that best indicates to the nurse that the client understands the action of this drug is

A client needs insertion of a long tube for intestinal decompression. The tube that is inappropriate for intestinal decompression is the

An important health promotion activity for nurses to teach clients with chronic gastritis is to

Before tube insertion, the nurse performs the NEX measurement, which is the

A nurse is caring for a client with severe burns. The client complains of abdominal pain and begins vomiting blood. The nurse anticipates diagnostic testing to determine if the client has developed

A client in the emergency department is hemorrhaging from a peptic ulcer and is being prepared quickly for emergency surgery. The nurse notes that the client is crying and reaches for the nurse frequently. The best response by the nurse to this client is to

The nurse has just finished inserting a nasogastric (NG) tube in a client who has difficulty swallowing. The best measure to test for placement of the tube is

A nurse is caring for a patient who had surgery and will be receiving chemotherapy and radiation treatment for stage III gastric cancer. The client is planning several extensive trips after the chemotherapy and radiation are finished. Which statement by the nurse is most appropriate at this time?