Digestive & Gastrointestinal System Disorders | NCLEX Quiz 79

1. A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure:

Decreases food absorption in the stomach

Heals the gastric mucosa

Halts stress reactions

Reduces the stimulus to acid secretions

A vagotomy. or cutting the vagus nerve. is done to eliminate parasympathetic stimulation of gastric secretion.

Explanation

A vagotomy. or cutting the vagus nerve. is done to eliminate parasympathetic stimulation of gastric secretion.

2. 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:

Cutting the vagus nerve

Removing the distal portion of the stomach

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

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

Option 4 describes the procedure for a pyloroplasty. A vagotomy involves cutting the vagus nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth II procedure involves removal of the ulcer and a large portion of the tissue that produces hydrochloric acid.

Explanation

Option 4 describes the procedure for a pyloroplasty. A vagotomy involves cutting the vagus nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth II procedure involves removal of the ulcer and a large portion of the tissue that produces hydrochloric acid.

3. Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection?

Monitoring gastric pH to detect complications

Assessing for bowel sounds

Providing nutritional support

Monitoring for symptoms of hemorrhage

The client should be monitored closely for signs and symptoms of hemorrhage. such as bright red blood in the nasogastric tube suction. tachycardia. or a drop in blood pressure. Gastric pH may be monitored to evaluate the need for histamine-2 receptor antagonists. Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs should be addressed soon after surgery.

Explanation

The client should be monitored closely for signs and symptoms of hemorrhage. such as bright red blood in the nasogastric tube suction. tachycardia. or a drop in blood pressure. Gastric pH may be monitored to evaluate the need for histamine-2 receptor antagonists. Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs should be addressed soon after surgery.

4. The nurse provides medication instructions to a client with peptic ulcer disease. Which statement. if made by the client. indicates the best understanding of the medication therapy?

“The cimetidine (Tagamet) will cause me to produce less stomach acid.”

“Sucralfate (Carafate) will change the fluid in my stomach.”

“Antacids will coat my stomach.”

“Omeprazole (Prilosec) will coat the ulcer and help it heal.”

Cimetidine (Tagamet). a histamine H2 receptor antagonist. will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.

Explanation

Cimetidine (Tagamet). a histamine H2 receptor antagonist. will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.

5. The nurse would assess the client experiencing an acute episode of cholecystitis for pain that is located in the right

Upper quadrant and radiates to the left scapula and shoulder

Upper quadrant and radiates to the right scapula and shoulder

Lower quadrant and radiates to the umbilicus

Lower quadrant and radiates to the back

During an acute “gallbladder attack.” the client may complain of severe right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern on dermatomes in the body.

Explanation

During an acute “gallbladder attack.” the client may complain of severe right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern on dermatomes in the body.

6. Which of the following tests is most commonly used to diagnose cholecystitis?

Abdominal CT scan

Abdominal ultrasound

Barium swallow

Endoscopy

An abdominal ultrasound can show if the gallbladder is enlarged. if gallstones are present. if the gallbladder wall is thickened. or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis. but it usually isn’t necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus. stomach. and duodenum.

Explanation

An abdominal ultrasound can show if the gallbladder is enlarged. if gallstones are present. if the gallbladder wall is thickened. or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis. but it usually isn’t necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus. stomach. and duodenum.

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

Blood replacement

Antacid administration

Nasogastric tube suction

Fluid and electrolyte replacement

Antacids aren’t helpful in perforation. The client should be treated with antibiotics as well as fluid. electrolyte. and blood replacement. NG tube suction should also be performed to prevent further spillage of stomach contents into the peritoneal cavity.

Explanation

Antacids aren’t helpful in perforation. The client should be treated with antibiotics as well as fluid. electrolyte. and blood replacement. NG tube suction should also be performed to prevent further spillage of stomach contents into the peritoneal cavity.

8. Which of the following symptoms best describes Murphy's sign?

Periumbilical ecchymosis exists

On deep palpation and release. pain in elicited

On deep inspiration. pain is elicited and breathing stops

Abdominal muscles are tightened in anticipation of palpation

Murphy’s sign is elicited when the client reacts to pain and stops breathing. It’s a common finding in clients with cholecystitis. Periumbilical ecchymosis. Cullen’s sign. is present in peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles in anticipation of palpation is guarding.

Explanation

Murphy’s sign is elicited when the client reacts to pain and stops breathing. It’s a common finding in clients with cholecystitis. Periumbilical ecchymosis. Cullen’s sign. is present in peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles in anticipation of palpation is guarding.

9. Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications?

To inhibit mucus production

To neutralize acid production

To stimulate mucus production

To stimulate hydrogen ion diffusion back into the mucosa

The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion diffusion back into the mucosa. resulting in accelerated ulcer healing. Antacids neutralize acid production.

Explanation

The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion diffusion back into the mucosa. resulting in accelerated ulcer healing. Antacids neutralize acid production.

10. When counseling a client in ways to prevent cholecystitis. which of the following guidelines is most important?

Eat a low-protein diet

Eat a low-fat. low-cholesterol diet

Limit exercise to 10 minutes/day

Keep weight proportionate to height

Obesity is a known cause of gallstones. and maintaining a recommended weight will help protect against gallstones. Excessive dietary intake of cholesterol is associated with the development of gallstones in many people. Dietary protein isn’t implicated in cholecystitis. Liquid protein and low-calorie diets (with rapid weight loss of more than 5 lb [2.3kg] per week) are implicated as the cause of some cases of cholecystitis. Regular exercise (30 minutes/three times a week) may help reduce weight and improve fat metabolism. Reducing stress may reduce bile production. which may also indirectly decrease the chances of developing cholecystitis.

Explanation

Obesity is a known cause of gallstones. and maintaining a recommended weight will help protect against gallstones. Excessive dietary intake of cholesterol is associated with the development of gallstones in many people. Dietary protein isn’t implicated in cholecystitis. Liquid protein and low-calorie diets (with rapid weight loss of more than 5 lb [2.3kg] per week) are implicated as the cause of some cases of cholecystitis. Regular exercise (30 minutes/three times a week) may help reduce weight and improve fat metabolism. Reducing stress may reduce bile production. which may also indirectly decrease the chances of developing cholecystitis.