Gastric and Duodenal Disorders
A nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When teaching the
patient about his new diagnosis, how should the nurse best describe a peptic ulcer?
A) Inflammation of the lining of the stomach
B) Erosion of the lining of the stomach or intestine
C) Bleeding from the mucosa in the stomach
D) Viral invasion of the stomach wall
Ans: B
Feedback:
A peptic ulcer is erosion of the lining of the stomach or intestine. Peptic ulcers are often accompanied by
bleeding and inflammation, but these are not the definitive characteristics.
2. A patient comes to the clinic complaining of pain in the epigastric region. What assessment question
during the health interview would most help the nurse determine if the patient has a peptic ulcer?
A) Does your pain resolve when you have something to eat?
B) Do over-the-counter pain medications help your pain?
C) Does your pain get worse if you get up and do some exercise?
D) Do you find that your pain is worse when you need to have a bowel movement?
Ans: A
Feedback:
Pain relief after eating is associated with duodenal ulcers. The pain of peptic ulcers is generally
unrelated to activity or bowel function and may or may not respond to analgesics.
3. A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole (Prilosec). How
should the nurse best describe this medications therapeutic action?
A) This medication will reduce the amount of acid secreted in your stomach.
B) This medication will make the lining of your stomach more resistant to damage.
C) This medication will specifically address the pain that accompanies peptic ulcer disease.
D)
This medication will help your stomach lining to repair itself.
Ans: A
Feedback:
Proton pump inhibitors like Prilosec inhibit the synthesis of stomach acid. PPIs do not increase the
durability of the stomach lining, relieve pain, or stimulate tissue repair.
4. A nurse is admitting a patient diagnosed with late-stage gastric cancer. The patients family is distraught
and angry that she was not diagnosed earlier in the course of her disease. What factor contributes to the
fact that gastric cancer is often detected at a later stage?
A) Gastric cancer does not cause signs or symptoms until metastasis has occurred.
B) Adherence to screening recommendations for gastric cancer is exceptionally low.
C) Early symptoms of gastric cancer are usually attributed to constipation.
D) The early symptoms of gastric cancer are usually not alarming or highly unusual.
Ans: D
Feedback:
Symptoms of early gastric cancer, such as pain relieved by antacids, resemble those of benign ulcers and
are seldom definitive. Symptoms are rarely a cause for alarm or for detailed diagnostic testing.
Symptoms precede metastasis, however, and do not include constipation.
5. A nurse is preparing to discharge a patient after recovery from gastric surgery. What is an appropriate
discharge outcome for this patient?
A) The patients bowel movements maintain a loose consistency.
B) The patient is able to tolerate three large meals a day.
C) The patient maintains or gains weight.
D) The patient consumes a diet high in calcium.
Ans: C
Feedback:
Expected outcomes for the patient following gastric surgery include ensuring that the patient is
maintaining or gaining weight (patient should be weighed daily), experiencing no excessive diarrhea,
and tolerating six small meals a day. Patients may require vitamin B12 supplementation by the
intramuscular route and do not require a diet excessively rich in calcium.
6. A nurse caring for a patient who has had bariatric surgery is developing a teaching plan in anticipation of
the patients discharge. Which of the following is essential to include?
A) Drink a minimum of 12 ounces of fluid with each meal.
B) Eat several small meals daily spaced at equal intervals.
C) Choose foods that are high in simple carbohydrates.
D) Sit upright when eating and for 30 minutes afterward.
Ans: B
Feedback:
Due to decreased stomach capacity, the patient must consume small meals at intervals to meet nutritional
requirements while avoiding a feeling of fullness and complications such as dumping syndrome. The
patient should not consume fluids with meals and low-Fowlers positioning is recommended during and
after meals. Carbohydrates should be limited.
7. A nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the
data should the nurse consider most significantly related to the etiology of the patients health problem?
A) Consumes one or more protein drinks daily.
B) Takes over-the-counter antacids frequently throughout the day.
C) Smokes one pack of cigarettes daily.
D) Reports a history of social drinking on a weekly basis.
Ans: C
Feedback:
Nicotine reduces secretion of pancreatic bicarbonate, which inhibits neutralization of gastric acid and
can underlie gastritis. Protein drinks do not result in gastric inflammation. Antacid use is a response to
experiencing symptoms of gastritis, not the etiology of gastritis. Alcohol ingestion can lead to gastritis;
however, this generally occurs in patients with a history of consumption of alcohol on a daily basis.
8. A nurse in the postanesthesia care unit admits a patient following resection of a gastric tumor. Following
immediate recovery, the patient should be placed in which position to facilitate patient comfort and
gastric emptying?
A) Fowlers
B) Supine
C) Left lateral
D) Left Sims
Ans: A
Feedback:
Positioning the patient in a Fowlers position postoperatively promotes comfort and facilitates emptying
of the stomach following gastric surgery. Any position that involves lying down delays stomach
emptying and is not recommended for this type of patient. Supine positioning and the left lateral (left
Sims) position do not achieve this goal.
9. A community health nurse is preparing for an initial home visit to a patient discharged following a total
gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most
likely to include?
A) Enteral feeding via gastrostomy tube (G tube)
B) Gastrointestinal decompression by nasogastric tube
C) Periodic assessment for esophageal distension
D) Monthly administration of injections of vitamin B12
Ans: D
Feedback:
Since vitamin B12 is absorbed in the stomach, the patient requires vitamin B12 replacement to prevent
pernicious anemia. A gastrectomy precludes the use of a G tube. Since the stomach is absent, a
nasogastric tube would not be indicated. As well, this is not possible in the home setting. Since there is
no stomach to act as a reservoir and fluids and nutrients are passing directly into the jejunum, distension
is unlikely.
10. A nurse is assessing a patient who has peptic ulcer disease. The patient requests more information about
the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct
the patient?
A) Most affected patients acquired the infection during international travel.
B) Infection typically occurs due to ingestion of contaminated food and water.
C) Many people possess genetic factors causing a predisposition to H. pylori infection.
D) The H. pylori microorganism is endemic in warm, moist climates.
Ans: B
Feedback:
Most peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be
acquired through ingestion of food and water. The organism is endemic to all areas of the United States.
Genetic factors have not been identified.
11. A patient who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the
patients condition is now stable. For the next several hours, the nurse caring for this patient should
assess for what signs and symptoms of recurrence?
A) Tachycardia, hypotension, and tachypnea
B) Tarry, foul-smelling stools
C) Diaphoresis and sudden onset of abdominal pain
D) Sudden thirst, unrelieved by oral fluid administration
Ans: A
Feedback:
Tachycardia, hypotension, and tachypnea are signs of recurrent bleeding. Patients who have had one GI
bleed are at risk for recurrence. Tarry stools are expected short-term findings after a hemorrhage.
Hemorrhage is not normally associated with sudden thirst or diaphoresis.
12. A patient presents to the walk-in clinic complaining of vomiting and burning in her mid-epigastria. The
nurse knows that in the process of confirming peptic ulcer disease, the physician is likely to order a
diagnostic test to detect the presence of what?
A) Infection with Helicobacter pylori
B) Excessive stomach acid secretion
C) An incompetent pyloric sphincter
D) A metabolic acidbase imbalance
Ans: A
Feedback:
H. pylori infection may be determined by endoscopy and histologic examination of a tissue specimen
obtained by biopsy, or a rapid urease test of the biopsy specimen. Excessive stomach acid secretion leads
to gastritis; however, peptic ulcers are caused by colonization of the stomach by H. pylori. Sphincter
dysfunction and acidbase imbalances do not cause peptic ulcer disease.
13. A patient with a peptic ulcer disease has had metronidazole (Flagyl) added to his current medication
regimen. What health education related to this medication should the nurse provide?
A) Take the medication on an empty stomach.
B) Take up to one extra dose per day if stomach pain persists.
C) Take at bedtime to mitigate the effects of drowsiness.
D) Avoid drinking alcohol while taking the drug.
Ans: D
Feedback:
Alcohol must be avoided when taking Flagyl and the medication should be taken with food. This drug
does not cause drowsiness and the dose should not be adjusted by the patient.
14. A patient was treated in the emergency department and critical care unit after ingesting bleach. What
possible complication of the resulting gastritis should the nurse recognize?
A) Esophageal or pyloric obstruction related to scarring
B) Uncontrolled proliferation of H. pylori
C) Gastric hyperacidity related to excessive gastrin secretion
D) Chronic referred pain in the lower abdomen
Ans: A
Feedback:
A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the
mucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis
(narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom of
peptic ulcer disease, but would not be an expected finding for a patient who has ingested a corrosive
substance. Bacterial proliferation and hyperacidity would not occur.
15. A patient who underwent gastric banding 3 days ago is having her diet progressed on a daily basis.
Following her latest meal, the patient complains of dizziness and palpitations. Inspection reveals that the
patient is diaphoretic. What is the nurses best action?
A) Insert a nasogastric tube promptly.
B) Reposition the patient supine.
C) Monitor the patient closely for further signs of dumping syndrome.
D) Assess the patient for signs and symptoms of aspiration.
Ans: C
Feedback:
The patients symptoms are characteristic of dumping syndrome, which results in a sensation of fullness,
weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. Aspiration is a
less likely cause for the patients symptoms. Supine positioning will likely exacerbate the symptoms and
insertion of an NG tube is contraindicated due to the nature of the patients surgery.
16. A patient is one month postoperative following restrictive bariatric surgery. The patient tells the clinic
nurse that he has been having trouble swallowing for the past few days. What recommendation should
the nurse make?
A) Eating more slowly and chewing food more thoroughly
B) Taking an OTC antacid or drinking a glass of milk prior to each meal
C) Chewing gum to cause relaxation of the lower esophageal sphincter
D) Drinking at least 12 ounces of liquid with each meal
Ans: A
Feedback:
Dysphagia may be prevented by educating patients to eat slowly, to chew food thoroughly, and to avoid
eating tough foods such as steak or dry chicken or doughy bread. After bariatric procedures, patients
should normally not drink beverages with meals. Medications or chewing gum will not alleviate this
problem.
17. A patient is receiving education about his upcoming Billroth I procedure (gastroduodenostomy). This
patient should be informed that he may experience which of the following adverse effects associated
with this procedure?
A) Persistent feelings of hunger and thirst
B) Constipation or bowel incontinence
C) Diarrhea and feelings of fullness
D) Gastric reflux and belching
Ans: C
Feedback:
Following a Billroth I, the patient may have problems with feelings of fullness, dumping syndrome, and
diarrhea. Hunger and thirst, constipation, and gastric reflux are not adverse effects associated with this
procedure.
18. A patient has experienced symptoms of dumping syndrome following bariatric surgery. To what
physiologic phenomenon does the nurse attribute this syndrome?
A) Irritation of the phrenic nerve due to diaphragmatic pressure
B) Chronic malabsorption of iron and vitamins A and C
C) Reflux of bile into the distal esophagus
D) A sudden release of peptides
Ans: D
Feedback:
For many years, it had been theorized that the hypertonic gastric food boluses that quickly transit into
the intestines drew extracellular fluid from the circulating blood volume into the small intestines to
dilute the high concentration of electrolytes and sugars, resulting in symptoms. Now, it is thought that
this rapid transit of the food bolus from the stomach into the small intestines instead causes a rapid and
exuberant release of metabolic peptides that are responsible for the symptoms of dumping syndrome. It
is not a result of phrenic nerve irritation, malabsorption, or bile reflux.
19. A patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses
the obese patient knowing that in addition to meeting the criterion of morbid obesity, a candidate for
bariatric surgery must also demonstrate what?
A) Knowledge of the causes of obesity and its associated risks
B) Adequate understanding of required lifestyle changes
C) Positive body image and high self-esteem
D) Insight into why past weight loss efforts failed
Ans: B
Feedback:
Patients seeking bariatric surgery should be free of serious mental disorders and motivated to comply with lifestyle
changes related to eating patterns, dietary choices, and elimination. While assessment of knowledge about causes of
obesity and its associated risks as well as insight into the reasons why previous diets have been ineffective are included in
the clients plan of care, these do not predict positive client outcomes following bariatric surgery. Most obese patients have
an impaired body image and alteration in self-esteem. An obese patient with a positive body image would be unlikely to
seek this surgery unless he or she was experiencing significant comorbidities.
20. A nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic
nonsteroidal anti-inflammatory drug (NSAID) use. The patient has recently been prescribed misoprostol
(Cytotec). What would the nurse be most accurate in informing the patient about the drug?
A) It reduces the stomachs volume of hydrochloric acid
B) It increases the speed of gastric emptying
C) It protects the stomachs lining
D) It increases lower esophageal sphincter pressure
Ans: C
Feedback:
Misoprostol is a synthetic prostaglandin that, like prostaglandin, protects the gastric mucosa. NSAIDs
decrease prostaglandin production and predispose the patient to peptic ulceration. Misoprostol does not
reduce gastric acidity, improve emptying of the stomach, or increase lower esophageal sphincter pressure.
21. A nurse is providing anticipator guidance to a patient who is preparing for bariatric surgery. The nurse
learns that the patient is anxious about numerous aspects of the surgery. What intervention is most
appropriate to alleviate the patients anxiety?
A) Emphasize the fact that bariatric surgery has a low risk of complications.
B) Encourage the patient to focus on the benefits of the surgery.
C) Facilitate the patients contact with a support group.
D) Obtain an order for a PRN benzodiazepine.
Ans: C
Feedback:
Support groups can be highly beneficial in relieving preoperative and postoperative anxiety and in
promoting healthy coping. This is preferable to antianxiety medications. Downplaying the risks of
surgery or focusing solely on the benefits is a simplistic and patronizing approach.
22. A patient has just been diagnosed with acute gastritis after presenting in distress to the emergency
department with abdominal symptoms. What would be the nursing care most needed by the patient at
this time?
A) Teaching the patient about necessary nutritional modification
B) Helping the patient weigh treatment options
C) Teaching the patient about the etiology of gastritis
D) Providing the patient with physical and emotional support
Ans: D
Feedback:
For acute gastritis, the nurse provides physical and emotional support and helps the patient manage the
symptoms, which may include nausea, vomiting, heartburn, and fatigue. The scenario describes a newly
diagnosed patient; teaching about the etiology of the disease, lifestyle modifications, or various
treatment options would be best provided at a later time.
23. A nurse is providing care for a patient who is postoperative day 2 following gastric surgery. The nurses
assessment should be planned in light of the possibility of what potential complications? Select all that
apply.
A) Malignant hyperthermia
B) Atelectasis
C) Pneumonia
D) Metabolic imbalances
E) Chronic gastritis
Ans: B, C, D
Feedback:
After surgery, the nurse assesses the patient for complications secondary to the surgical intervention,
such as pneumonia, atelectasis, or metabolic imbalances resulting from the GI disruption. Malignant
hyperthermia is an intraoperative complication. Chronic gastritis is not a surgical complication.
24. A patient is undergoing diagnostic testing for a tumor of the small intestine. What are the most likely
symptoms that prompted the patient to first seek care?
A) Hematemesis and persistent sensation of fullness
B) Abdominal bloating and recurrent constipation
C) Intermittent pain and bloody stool
D) Unexplained bowel incontinence and fatty stools
Ans: C
Feedback:
When the patient is symptomatic from a tumor of the small intestine, benign tumors often present with
intermittent pain. The next most common presentation is occult bleeding. The other listed signs and
symptoms are not normally associated with the presentation of small intestinal tumors.
25. A patient is recovering in the hospital following gastrectomy. The nurse notes that the patient has
become increasingly difficult to engage and has had several angry outbursts at various staff members in
recent days. The nurses attempts at therapeutic dialogue have been rebuffed. What is the nurses most
appropriate action?
A) Ask the patients primary care provider to liaise between the nurse and the patient.
B) Delegate care of the patient to a colleague.
C) Limit contact with the patient in order to provide privacy.
D) Make appropriate referrals to services that provide psychosocial support.
Ans: D
Feedback:
The nurse should enlist the services of clergy, psychiatric clinical nurse specialists, psychologists, social
workers, and psychiatrists, if needed. This is preferable to delegating care, since the patient has become
angry with other care providers as well. It is impractical and inappropriate to expect the primary care
provider to act as a liaison. It would be inappropriate and unsafe to simply limit contact with the patient.
26. A patient has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric
outlet obstruction (GOO). What is the nurses priority intervention?
A) Administration of antiemetics
B) Insertion of an NG tube for decompression
C) Infusion of hypotonic IV solution
D) Administration of proton pump inhibitors as ordered
Ans: B
Feedback:
In treating the patient with gastric outlet obstruction, the first consideration is to insert an NG tube to
decompress the stomach. This is a priority over fluid or medication administration.
27. A patient with a history of peptic ulcer disease has presented to the emergency department (ED) in
distress. What assessment finding would lead the ED nurse to suspect that the patient has a perforated
ulcer?
A) The patient has abdominal bloating that developed rapidly.
B) The patient has a rigid, boardlike abdomen that is tender.
C) The patient is experiencing intense lower right quadrant pain.
D) The patient is experiencing dizziness and confusion with no apparent hemodynamic changes.
Ans: B
Feedback:
An extremely tender and rigid (boardlike) abdomen is suggestive of a perforated ulcer. None of the other
listed signs and symptoms is suggestive of a perforated ulcer.
28. Diagnostic imaging and physical assessment have revealed that a patient with peptic ulcer disease has
suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as
soon as possible in order to prevent the development of what complication?
A) Peritonitis
B) Gastritis
C) Gastroesophageal reflux
D) Acute pancreatitis
Ans: A
Feedback:
Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without
warning. Chemical peritonitis develops within a few hours of perforation and is followed by bacterial
peritonitis. Gastritis, reflux, and pancreatitis are not acute complications of a perforated ulcer.
29. A nurse is performing the admission assessment of a patient whose high body mass index (BMI)
corresponds to class III obesity. In order to ensure empathic and patient-centered care, the nurse should
do which of the following?
A) Examine ones own attitudes towards obesity in general and the patient in particular.
B) Dialogue with the patient about the lifestyle and psychosocial factors that resulted in obesity.
C) Describe ones own struggles with weight gain and weight loss to the patient.
D) Elicit the patients short-term and long-term goals for weight loss.
Ans: A
Feedback:
Studies suggest that health care providers, including nurses, harbor negative attitudes towards obese
patients. Nurses have a responsibility to examine these attitudes and change them accordingly. This is
foundational to all other areas of assessing this patient.
30. A patient has been prescribed orlistat (Xenical) for the treatment of obesity. When providing relevant
health education for this patient, the nurse should ensure the patient is aware of what potential adverse
effect of treatment?
A) Bowel incontinence
B) Flatus with oily discharge
C) Abdominal pain
D) Heat intolerance
Ans: B
Feedback:
Side effects of orlistat include increased frequency of bowel movements, gas with oily discharge,
decreased food absorption, decreased bile flow, and decreased absorption of some vitamins. This drug
does not cause bowel incontinence, abdominal pain, or heat intolerance.
31. A patient who is obese has been unable to lose weight successfully using lifestyle modifications and has
mentioned the possibility of using weight-loss medications. What should the nurse teach the patient
about pharmacologic interventions for the treatment of obesity?
A) Weight loss drugs have many side effects, and most doctors think they’ll all be off the market in a few years.
B) There used to be a lot of hope that medications would help people lose weight, but its been shown to be mostly a
placebo effect.
C) Medications can be helpful, but few people achieve and maintain their desired weight loss with medications alone.
D) Medications are rapidly become the preferred method of weight loss in people for whom diet and exercise have not
worked.
Ans: C
Feedback:
Though antiobesity drugs help some patients lose weight, their use rarely results in loss of more than
10% of total body weight. Patients are consequently unlikely to attain their desired weight through
medication alone. They are not predicted to disappear from the market and results are not attributed to a
placebo effect.
32. A patient has been diagnosed with peptic ulcer disease and the nurse is reviewing his prescribed
medication regimen with him. What is currently the most commonly used drug regimen for peptic
ulcers?
A) Bismuth salts, antivirals, and histamine-2 (H2) antagonists
B) H2 antagonists, antibiotics, and bicarbonate salts
C) Bicarbonate salts, antibiotics, and ZES
D) Antibiotics, proton pump inhibitors, and bismuth salts
Ans: D
Feedback:
Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton
pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. H2 receptor antagonists are used
to treat NSAID-induced ulcers and other ulcers not associated with H. pylori infection, but they are not
the drug of choice. Bicarbonate salts are not used. ZES is the Zollinger-Ellison syndrome and not a drug.
33. A patient who is obese is exploring bariatric surgery options and presented to a bariatric clinic for
preliminary investigation. The nurse interviews the patient, analyzing and documenting the data. Which
of the following nursing diagnoses may be a contraindication for bariatric surgery?
A) Disturbed Body Image Related to Obesity
B) Deficient Knowledge Related to Risks and Expectations of Surgery
C) Anxiety Related to Surgery
D) Chronic Low Self-Esteem Related to Obesity
Ans: B
Feedback:
It is expected that patients seeking bariatric surgery may have challenges with body image and selfesteem
related to their obesity. Anxiety is also expected when facing surgery. However, if the patients
knowledge remains deficient regarding the risks and realistic expectations for surgery, this may show
that the patient is not an appropriate surgical candidate.
34. A patient has recently received a diagnosis of gastric cancer; the nurse is aware of the importance of
assessing the patients level of anxiety. Which of the following actions is most likely to accomplish this?
A) The nurse gauges the patients response to hypothetical outcomes.
B) The patient is encouraged to express fears openly.
C) The nurse provides detailed and accurate information about the disease.
D) The nurse closely observes the patients body language.
Ans: B
Feedback:
Encouraging the patient to discuss his or her fears and anxieties is usually the best way to assess a
patients anxiety. Presenting hypothetical situations is a surreptitious and possibly inaccurate way of
assessing anxiety. Observing body language is part of assessment, but it is not the complete assessment.
Presenting information may alleviate anxiety for some patients, but it is not an assessment.
35. A patient has received a diagnosis of gastric cancer and is awaiting a surgical date. During the
preoperative period, the patient should adopt what dietary guidelines?
A) Eat small, frequent meals with high calorie and vitamin content.
B) Eat frequent meals with an equal balance of fat, carbohydrates, and protein.
C) Eat frequent, low-fat meals with high protein content.
D) Try to maintain the pre-diagnosis pattern of eating.
Ans: A
Feedback:
The nurse encourages the patient to eat small, frequent portions of nonirritating foods to decrease gastric
irritation. Food supplements should be high in calories, as well as vitamins A and C and iron, to enhance
tissue repair.
36. A nurse is caring for a patient who has a diagnosis of GI bleed. During shift assessment, the nurse finds
the patient to betachycardic and hypotensive, and the patient has an episode of hematemesis while the
nurse is in the room. In addition to monitoring the patients vital signs and level of conscious, what would
be a priority nursing action for this patient?
A) Place the patient in a prone position.
B) Provide the patient with ice water to slow any GI bleeding.
C) Prepare for the insertion of an NG tube.
D) Notify the physician.
Ans: D
Feedback:
The nurse must always be alert for any indicators of hemorrhagic gastritis, which include hematemesis
(vomiting of blood), tachycardia, and hypotension. If these occur, the physician is notified and the
patients vital signs are monitored as the patients condition warrants. Putting the patient in a prone
position could lead to aspiration. Giving ice water is contraindicated as it would stimulate more
vomiting.
37. A nurse is caring for a patient hospitalized with an exacerbation of chronic gastritis. What health
promotion topic should the nurse emphasize?
A) Strategies for maintaining an alkaline gastric environment
B) Safe technique for self-suctioning
C) Techniques for positioning correctly to promote gastric healing
D) Strategies for avoiding irritating foods and beverages
Ans: D
Feedback:
Measures to help relieve pain include instructing the patient to avoid foods and beverages that may be
irritating to the gastric mucosa and instructing the patient about the correct use of medications to relieve
chronic gastritis. An alkaline gastric environment is neither possible nor desirable. There is no plausible
need for self-suctioning. Positioning does not have a significant effect on the presence or absence of
gastric healing.
38. A patient with gastritis required hospital treatment for an exacerbation of symptoms and receives a
subsequent diagnosis of pernicious anemia due to malabsorption. When planning the patients continuing
care in the home setting, what assessment question is most relevant?
A) Does anyone in your family have experience at giving injections?
B) Are you going to be anywhere with strong sunlight in the next few months?
C) Are you aware of your blood type?
D) Do any of your family members have training in first aid?
Ans: A
Feedback:
Patients with malabsorption of vitamin B12 need information about lifelong vitamin B12injections; the
nurse may instruct a family member or caregiver how to administer the injections or make arrangements
for the patient to receive the injections from a health care provider. Questions addressing sun exposure,
blood type and first aid are not directly relevant.
39. A nurse is presenting a class at a bariatric clinic about the different types of surgical procedures offered
by the clinic. When describing the implications of different types of surgeries, the nurse should address
which of the following topics? Select all that apply.
A) Specific lifestyle changes associated with each procedure
B) Implications of each procedure for eating habits
C) Effects of different surgeries on bowel function
D) Effects of various bariatric surgeries on fertility
E) Effects of different surgeries on safety of future immunizations
Ans: A, B, C
Feedback:
Different bariatric surgical procedures entail different lifestyle modifications; patients must be well
informed about the specific lifestyle changes, eating habits, and bowel habits that may result from a
particular procedure. Bariatric surgeries do not influence the future use of immunizations or fertility,
though pregnancy should be avoided for 18 months after bariatric surgery.
40. A patient has come to the clinic complaining of pain just above her umbilicus. When assessing the
patient, the nurse notes Sister Mary Josephs nodules. The nurse should refer the patient to the primary
care provider to be assessed for what health problem?
A) A GI malignancy
B) Dumping syndrome
C) Peptic ulcer disease
D) Esophageal/gastric obstruction
Ans: A
Feedback:
Palpable nodules around the umbilicus, called Sister Mary Josephs nodules, are a sign of a GI
malignancy, usually a gastric cancer. This would not be a sign of dumping syndrome, peptic ulcer
disease, or esophageal/gastric obstruction.