Brunner: Medical-Surgical Nursing, 10th Edition

Chapter 37: Management of Patients With Gastric and Duodenal Disorders

1. The patient has been diagnosed with a peptic ulcer. Which of the following best describes a
peptic ulcer?
A) Inflammation of the lining of the stomach
B) Erosion of the lining of the stomach or intestine
C) Bleeding from the mucosa in the stomach
D) Bacterial invasion of the stomach wall

Ans: B
Chapter: 37
Client Needs: IV-4
Cognitive Categories: Knowledge
Concepts and Processes: Nursing Process
Difficulty: Easy
Objective: 1
Feedback: A peptic ulcer is erosion of the lining of the stomach or intestine.

2. A patient with a peptic ulcer may describe the pain as:

A) Gnawing
B) Sharp stabbing
C) Over-distended feeling
D) Cramping or aching

Ans: A
Chapter: 37
Client Needs: IV-4
Cognitive Categories: Application
Concepts and Processes: Nursing Process
Difficulty: Moderate
Objective: 1
Feedback: Patients with ulcers generally describe the pain as a gnawing or dull pain. They may
also complain of a burning sensation.

3. A patient has been prescribed ranitidine. Which of the following statements would indicate
that the patient correctly understand the action of this medication?
A) “The medication inhibits acid secretions.”
B) “The medication is an antibiotic.”
C) “The medication is an analgesic.”
D) “The medication will repair my ulcer.”

Ans: A
Chapter: 37
Client Needs: IV-4
Cognitive Categories: Application
Concepts and Processes: Teaching/Learning
Difficulty: Difficult
Objective: 3
Feedback: The statement, “The medication inhibits acid secretions,” indicates that the patient
understands that the medication inhibits acid secretion. This medication does not act as an
antibiotic or analgesic, nor will it repair the ulcer.

4. Which of the following is a clinical manifestation of gastric tumors?

A) Initially cause little disturbance of gastric functions
B) May cause diarrhea
C) Low likelihood of metastatic disease
D) Primarily affects patients in their 30s

Ans: A
Chapter: 37
Client Needs: IV-2
Cognitive Categories: Comprehension
Concepts and Processes: Nursing Process
Difficulty: Difficult
Objective: 4
Feedback: The early symptoms of gastric cancer are not definitive because most of the tumors
begin on the lesser curvature where they cause little disturbance of gastric functions. Symptoms
include constipation and anorexia. There is a high incidence of metastasis because early
symptoms are not definitive.

5. Which of the following categories of drugs used for peptic ulcer disease exerts bacteriostatic
effects to eradicate bacteria in the gastric mucosa?
A) Bismuth salts
B) Histamine 2 (H2) receptor antagonists
C) Proton pump inhibitors
D) Cytoprotective drugs

Ans: A
Chapter: 37
Client Needs: IV-2
Cognitive Categories: Comprehension
Concepts and Processes: Nursing Process
Difficulty: Difficult
Objective: 4
Feedback: Bismuth salts exert bacteriostatic effects to eradicate bacteria in the gastric mucosa,
and H2 blockers inhibit acid secretion. Proton pump inhibitors decrease gastric acid secretion.
Cytoprotective agents protect the gastric mucosa by increasing mucus or creating a viscous
protective layer at the site of the ulcer.

6. Peptic ulcer pain is most likely to be relieved by which of the following methods?
A) Eating
B) Drinking milk
C) Suppressing emesis
D) Waiting 2 hours after eating

Ans: A
Chapter: 37
Client Needs: IV-3
Cognitive Categories: Knowledge
Concepts and Processes: Nursing Process
Difficulty: Moderate
Objective: 4
Feedback: Taking antacids, eating, or vomiting often relieves the pain. Pain occurs about 2
hours after eating. Milk is contraindicated in relieving peptic ulcer pain.

7. The patient is admitted with a peptic ulcer. The patient is complaining of right shoulder pain
and is hypotensive. What might this indicate?
A) The patient is positioned poorly.
B) The ulcer is perforated.
C) The patient has angina.
D) The patient has a pulmonary infection.

Ans: B
Chapter: 37
Client Needs: IV-4
Cognitive Categories: Analysis
Concepts and Processes: Nursing Process
Difficulty: Difficult
Objective: 4
Feedback: Pain accompanying ulcer perforation may be referred to the shoulders, especially the
right shoulder, because of irritation of the phrenic nerve in the diaphragm. Other symptoms
include hypotension and tachycardia; tender, rigid abdomen; vomiting; and collapse.

8. Which of the following signs or symptoms may indicate progressive gastric cancer?
A) Stomach pain relieved with antacids
B) Bloating
C) Diarrhea
D) Anemia

Ans: D
Chapter: 37
Client Needs: II-2
Cognitive Categories: Comprehension
Concepts and Processes: Nursing Process
Difficulty: Moderate
Objective: 6
Feedback: The early symptoms of gastric cancer and are often not definite. Some studies have
shown that early symptoms, such as pain relieved with antacids, resemble those of benign ulcers.
Symptoms of progressive disease include indigestion, anorexia, weight loss, abdominal pain,
constipation, anemia, and nausea and vomiting.

9. A morbidly obese patient has undergone a gastric bypass. Which of the following statements
indicates that the patient needs additional postoperative teaching?
A) “When will I have the staples removed from my stomach?”
B) “I will need to eat slower.”
C) “I will notify my physician if my stomach becomes distended.”
D) “I should eat six small meals a day.”

Ans: A
Chapter: 37
Client Needs: II-2
Cognitive Categories: Analysis
Concepts and Processes: Teaching/Learning
Difficulty: Moderate
Objective: 5
Feedback: The staples are not removed from the stomach after the surgery as they decrease the
volume the patient is able to eat. The patient should eat small frequent meals, watch for
distention, and eat meals slower.

10. The patient is 4 weeks following a total gastrectomy. Which of the following supplement
will the patient require indefinitely?
A) Vitamin C
B) Vitamin B12 injections
C) Calcium
D) Vitamin A

Ans: B
Chapter: 37
Client Needs: I-1
Cognitive Categories: Application
Concepts and Processes: Nursing Process
Difficulty: Moderate
Objective: 8
Feedback: If a total gastrectomy is preformed, the patient will require vitamin B12 injections
indefinitely. Total gastrectomy results in a lack of intrinsic factor, a gastric secretion required for
the absorption of vitamin B. Vitamin C, calcium, and vitamin A may be obtained with adequate
nutrition.

11. After gastric surgery, dietary self-management guidelines include:

A) Meals should contain more liquid items than dry.
B) Carbohydrate intake should be high.
C) Sucrose and glucose are to be increased.
D) Meals should contain more dry than liquid items.

Ans: D
Chapter: 37
Client Needs: IV-4
Cognitive Categories: Analysis
Concepts and Processes: Teaching/Learning
Difficulty: Difficult
Objective: 7
Feedback: Because of complications, such as dysphagia, gastric retention, bile reflux, and
dumping syndrome, that may occur in the gastric surgery patient, the nurse teaches the patient
that meals should contain more dry than liquid items. Smaller but more frequent meals should be
eaten; fat may be taken to tolerance, but carbohydrate intake should be kept low. Sucrose and
glucose are to be avoided because of fluid imbalances that may be caused during digestion in the
jejunum.

12. The patient is being discharged after gastric surgery, which of the following would be an
expected outcome after the patient is discharged?
A) The patient's bowel movements are loose.
B) The patient eats three meals a day.
C) The patient maintains a reasonable weight.
D) The patient has a diet high in vitamin B12.

Ans: C
Chapter: 37
Client Needs: IV-3
Cognitive Categories: Application
Concepts and Processes: Teaching/Learning
Difficulty: Moderate
Objective: 4
Feedback: Expected outcomes for the patient following gastric surgery include maintaining a
reasonable weight, experiencing no excessive diarrhea, and tolerating six small meals a day.

13. Which of the following menu items should be avoided by the patient who is taking
tetracycline therapy for eradication of Helicobacter pylori?
A) Red meat
B) Yogurt
C) Whole wheat bread
D) Nuts

Ans: B
Chapter: 37
Client Needs: IV-2
Cognitive Categories: Knowledge
Concepts and Processes: Nursing Process
Difficulty: Moderate
Objective: 4
Feedback: When taken with milk or dairy products, the effectiveness of tetracycline may be
reduced.
14. What are potential complications resulting from a Billroth II (gastrojejunostomy)?
A) Feelings of hunger
B) Constipation
C) Feeling of fullness
D) Gastric reflux

Ans: C
Chapter: 37
Client Needs: IV-4
Cognitive Categories: Comprehension
Concepts and Processes: Nursing Process
Difficulty: Difficult
Objective: 8
Feedback: Following a Billroth II, the patient may have problems with feelings of fullness,
dumping syndrome, and diarrhea. Hunger, constipation, and gastric reflux are not symptoms
associated with this procedure.

15. The nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping
syndrome, the nurse should advise the client to:
A) restrict fluid intake to 1 qt (1,000 ml)/day.
B) drink liquids only with meals.
C) not drink liquids 2 hours before meals.
D) drink liquids only between meals.

Ans: D
Chapter: 37
Client Needs: D-3
Cognitive Categories: Application
Concepts and Processes: Nursing Process
Difficulty: Difficult
Objective: 8
Feedback: A client who experiences dumping syndrome after a subtotal gastrectomy should be
advised to ingest liquids between meals rather than with meals. Taking fluids between meals
allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in
preventing rapid gastric emptying. There's no need to restrict the amount of fluids, just the time
when the client drinks fluids. Drinking liquids with meals increases the risk of dumping
syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small
amounts of water are allowable before meals.

16. During a routine follow-up examination, the nurse updates the client's medication history.
The client currently receives prednisone therapy. Concomitant use of an agent from which of the
following classes could increase the risk of peptic ulcer disease?
A) Antidiabetic agents, administered orally
B) Nonsteroidal anti-inflammatory drugs (NSAIDs)
C) Beta-adrenergic blockers
D) Contraceptive agents, administered orally

Ans: B
Chapter: 37
Client Needs: D-2
Cognitive Categories: Application
Concepts and Processes: Nursing Process
Difficulty: Moderate
Objective: 3
Feedback: Concomitant use of NSAIDs may increase the risk of a peptic ulcer; therefore, they
should be administered 2 hours before or 2 hours after prednisone. Oral antidiabetic agents, beta-
adrenergic blockers, and oral contraceptive agents don't increase the risk of peptic ulcer disease
when administered with prednisone.

17. A patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug
(NSAID) use is prescribed misoprostol (Cytotec). The nurse would be most accurate in
informing the patient that the drug:
A) reduces the stomach's volume of hydrochloric acid.
B) increases the speed of gastric emptying.
C) protects the stomach's lining.
D) increases lower esophageal sphincter pressure.

Ans: C
Chapter: 37
Client Needs: D-2
Cognitive Categories: Application
Concepts and Processes: Communication
Difficulty: Moderate
Objective: 4
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 doesn't reduce gastric acidity (option A), improve emptying of the
stomach (option B), or increase lower esophageal sphincter pressure (option D).

18. A patient with rheumatoid arthritis has a history of long-term nonsteroidal anti-inflammatory
drug (NSAID) use and, consequently, has developed peptic ulcer disease. To prevent and treat
this condition, the nurse should administer:
A) cyanocobalamin (vitamin B12).
B) ticlopidine (Ticlid).
C) prednisone (Deltasone).
D) misoprostol (Cytotec).

Ans: D
Chapter: 37
Client Needs: D-2
Cognitive Categories: Application
Concepts and Processes: Nursing Process
Difficulty: Moderate
Objective: 4
Feedback: NSAIDs decrease prostaglandin synthesis. Misoprostol (Cytotec), a synthetic analog
of prostaglandin, is used to treat and prevent NSAID-induced gastric ulcers. Cyanocobalamin,
option A, is used to treat vitamin B12 deficiency. Ticlopidine, option B, is an antiplatelet drug
used to reduce the risk of stroke. Prednisone, option C, is a glucocorticosteroid used to treat
several inflammatory disorders and may promote gastric ulcer development.