Brunner: Medical-Surgical Nursing, 11th Edition

Test Bank

Chapter 37: Management of Patients With Gastric and Duodenal Disorders

Multiple Choice

1. The patient has been diagnosed with a peptic ulcer. The patient asks the nurse, “What is 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
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 1
Patient Needs: D-4
Feedback: A peptic ulcer is erosion of the lining of the stomach or intestine.

2. The nurse asks the patient with a peptic ulcer to describe his pain. A patient with a peptic ulcer usually describes
the pain as:
A) Gnawing
B) Sharp stabbing
C) Overdistended feeling
D) Cramping or aching

Ans: A
Chapter: 37
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication/Documentation
Objective: 1
Patient Needs: D-4
Feedback: Patients with ulcers generally describe the pain as a gnawing or dull. 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
understands 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
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 3
Patient Needs: D-2
Feedback: The statement that “the medication inhibits acid secretions” indicates patient understanding. This
medication does not act as an antibiotic or analgesic, nor will it repair the ulcer.

4. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved
by:
A) Eating
B) Drinking milk
C) Suppressing emesis
D) Having a bowel movement

Ans: A
Chapter: 37
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Patient Needs: D-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.

5. A patient admitted with a peptic ulcer complains of right shoulder pain and is hypotensive. The nurse anticipates
that the causes for these symptoms are related to:
A) Improper positioning in the bed
B) Ulcer perforation
C) Angina
D) A pulmonary infection

Ans: B
Chapter: 37
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 1
Patient Needs: D-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.

6. The nurse is concerned that the patient is experiencing progressive gastric cancer when she assesses which
symptom?
A) Stomach pain relieved with antacids
B) Bloating
C) Diarrhea
D) Anemia

Ans: D
Chapter: 37
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 6
Patient Needs: D-4
Feedback: The early symptoms of gastric cancer 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, nausea, and vomiting.

7. The patient is being discharged after gastric surgery. What is an appropriate discharge outcome for this patient?
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 consumes a diet high in calcium.

Ans: C
Chapter: 37
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 8
Patient Needs: D-3
Feedback: Expected outcomes for the patient following gastric surgery include maintaining a reasonable weight,
experiencing no excessive diarrhea, and tolerating 6 small meals a day. Patients may require vitamin B 12
supplementation by the intramuscular route and do not require a diet excessively rich in calcium.

8. The nurse is bringing the meal tray to a patient who is receiving tetracycline therapy for the eradication of
Helicobacter pylori. Upon taking the cover off of the tray, the nurse recognizes that the patient will not be allowed to
eat which of the following foods?
A) Red meat
B) Yogurt
C) Whole wheat bread
D) Nuts

Ans: B
Chapter: 37
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Patient Needs: D-2
Feedback: When taken with milk or dairy products, the effectiveness of tetracycline may be reduced.

9. The nurse is receiving a report from the PACU about a patient who is returning to the unit after a Billroth II
(gastrojejunostomy). The nurse will assess for which complication related to this procedure?
A) Feeling of hunger
B) Constipation
C) Feeling of fullness
D) Gastric reflux
Ans: C
Chapter: 37
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 8
Patient Needs: D-3
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.

10. The nurse is caring for a patient who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse
should advise the patient to:
A) Restrict fluid intake to 1 qt (1000 mL)/day.
B) Drink liquids only with meals.
C) Maintain NPO status.
D) Drink liquids only between meals.

Ans: D
Chapter: 37
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Teaching/Learning
Objective: 8
Patient Needs: D-3
Feedback: A patient 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 patient 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.

11. During a routine follow-up examination, the nurse updates the patient's medication history. The patient 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
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-2
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, betaadrenergic blockers, and oral contraceptive
agents don't increase the risk of peptic ulcer disease when administered with prednisone.
12. 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
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication
Objective: 4
Patient Needs: D-2
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).

13. The nurse is developing a teaching plan for a patient who has undergone bariatric surgery.
Which information listed below is essential to include?
A) Drink a minimum of 90 cc of fluid with each meal.
B) Eat 6 small meals daily spaced at equal intervals.
C) Choose foods high in carbohydrates especially simple sugars.
D) Limit calories to no more than 1800 daily.

Ans: B
Chapter: 37
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 5
Patient Needs: D-3
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. This practice, as well as consumption of foods high in carbohydrates, contributes to the
development of dumping syndrome. Recommended caloric intake following surgery is generally less than 1000
calories per day.

14. The nurse is assessing an obese patient who expresses an interest in bariatric surgery. The nurse knows that in
addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate which of
the following?
A) Knowledge of the causes of obesity and its associated risks
B) Emotional stability and understanding of required lifestyle changes
C) Positive body image and high self-esteem
D) Insight into why their past weight loss efforts failed

Ans: B
Chapter: 37
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Patient Needs: C-1
Feedback: Patients seeking bariatric surgery must be evaluated by a psychiatrist, psychologist, or advanced-practice
mental health nurse to establish that they are free of serious mental disorders and are motivated to comply with
lifestyle changes related to eating patterns, dietary choices, and elimination. Obese patients are often unlikely to have
a positive body image due to the social stigma associated with obesity. 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 patient's plan of care, they do not predict positive patient 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 she or he was experiencing significant co-morbidities.

15. The nurse is caring for a 34-year-old obese female patient who underwent gastric banding 3 days ago. Essential
postoperative teaching for this patient should include instruction related to the importance of abstaining from which of
the following for the next two years?
A) Multivitamin supplements
B) Pregnancy
C) Antidepressants
D) Control-top panty hose

Ans: B
Chapter: 37
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 5
Patient Needs: D-4
Feedback: Women of childbearing age who have had bariatric surgery should avoid pregnancy for approximately 2
years until their weight stabilizes, and it is evident that their nutritional needs are being adequately met. Multivitamins
are generally recommended for the patient to supplement dietary sources of nutrients. Antidepressants may be taken
if clinically indicated. Control-top pantyhose may be uncomfortable postoperatively; however, they are not
contraindicated.

16. A patient is admitted to the emergency room after a suicide attempt during which she ingested liquid drain
cleaner. Her diagnosis is acute gastritis and esophagitis. Which of the following nursing actions is a priority
when caring for this patient?
A) Induce vomiting to minimize risk of esophageal damage.
B) Prepare the patient for an immediate endoscopy.
C) Administer an acidic antidote such as diluted vinegar.
D) Place the patient in high-Fowler's position to eliminate reflux.

Ans: C
Chapter: 37
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process, Caring
Objective: 1, 2
Patient Needs: D-1
Feedback: Emergency treatment of alkali ingestion consists of diluting and neutralizing the alkaline substance with an
acid. Diluted vinegar or lemon juice are commonly used. The patient is likely to require endoscopy to assess damage;
however, this would follow administration of an antidote. Inducing vomiting would exacerbate esophageal damage by
exposing esophageal tissues to the alkaline substance a second time. Maintaining the patient is high-Fowler's position
is indicated; however, the priority intervention is neutralizing the drain cleaner.
17. A middle-age patient presents at the community clinic with abdominal pains and heartburn, which he says have
persisted for several days following a particularly spicy meal. Which of the following complications would the nurse be
particularly likely to assess for?
A) Esophageal or pyloric obstruction related to scarring
B) Acute systemic infection related to peritonitis
C) Gastric hyperacidity related to excessive gastrin secretion
D) Chronic referred pain in the right shoulder

Ans: A
Chapter: 37
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Caring
Objective: 1
Patient Needs: D-3
Feedback: Acute gastritis can result from dietary indiscretion and may lead to scarring and stenosis often requiring
dilation. Acute systemic infection occurs following perforation. Perforation is not a common occurrence following
ingestion of a corrosive substance. Gastrin is a hormone secreted in the stomach. It is not normally found in the
esophagus. Chronic referred pain to the right shoulder is a symptom of peptic ulcer disease, but it would not be an
expected finding for a patient who has ingested a corrosive substance.

18. The nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data below
should the nurse consider most significantly related to the etiology of the patient's health problem?
A) Consumes one or more protein drinks daily.
B) Takes over-the-counter antacids frequently throughout the day.
C) Smokes two packs of cigarettes daily.
D) Reports a history of social drinking on a weekly basis.

Ans: C
Chapter: 37
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 2
Patient Needs: D-4
Feedback: Nicotine reduces secretion of pancreatic bicarbonate which inhibits neutralization of gastric acid. 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 daily consumption of alcohol. Protein drinks do not
result in gastric inflammation.

19. The nurse is assisting a patient with a peptic ulcer to select his dinner menu. Which beverage would be most
appropriate?
A) Vanilla milkshake
B) Decaffeinated coffee
C) Unsweetened iced tea
D) Room temperature grape juice

Ans: D
Chapter: 37
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 4
Patient Needs: D-1
Feedback: Coffee and tea, whether caffeinated or decaffeinated, stimulate gastric acid secretion. The same is true of
foods rich in milk and cream. Oversecretion of acid and hypermotility of the GI tract can be decreased by avoiding
extremes of temperature in food and beverages.

20. A patient presents with vomiting and burning in his midepigastrium. The nurse knows that to confirm peptic ulcer
disease, the physician is likely to order a diagnostic test to detect the presence of:
A) Infection with Helicobacter pylori
B) Excessive stomach acid secretion
C) Gastric irritation caused by NSAIDs
D) Overconsumption of spicy foods

Ans: A
Chapter: 37
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 1
Patient Needs: A-2
Feedback: Excessive stomach acid secretion, NSAIDs, and dietary indiscretion may all cause gastritis; however, peptic
ulcers are caused by colonization of the stomach by H. pylori.

21. A patient is admitted to the postanesthesia care unit following resection of a gastric tumor. In which position,
should the patient be placed to facilitate both patient comfort and gastric emptying?
A) Semi-Fowler's
B) Dorsal recumbent
C) Side-lying
D) Left Simm's

Ans: A
Chapter: 37
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Caring/Nursing Process
Objective: 7
Patient Needs: D-1
Feedback: Positioning the patient in a Semi-Fowler's position postoperatively promotes comfort and facilitates
emptying of the stomach following gastric surgery. Any position that involves lying down delays stomach emptying.

22. The nurse is caring for a patient who experienced a gastric hemorrhage. The bleeding has been controlled, and his
condition is now stable. The nurse's priority should be frequent assessment of the patient for which of the following?
A) Tachycardia, hypotension, and tachypnea
B) Tarry, foul smelling stools
C) “Coffee ground” material in the nasogastric tube drainage
D) Irritation of the nares and nasal mucosa

Ans: A
Chapter: 37
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 8
Patient Needs: D-3
Feedback: Tachycardia, hypotension, and tachypnea are signs of recurrent bleeding. Patients who have had one GI
bleed are at risk for reoccurrence. Tarry stools and presence of “coffee ground” material in drainage are expected
findings after a hemorrhage. The NG tube may be associated with nasal irritation. While this is an important concern
related to patient comfort, it is not a nursing priority.

23. The nurse is assessing a patient on antibiotic therapy who requests more information about the typical causes of
H. pylori infection. It would be appropriate for the nurse to instruct the patient that:
A) Most affected patients acquired the infection during international travel.
B) Infection typically occurs due to ingestion of contaminated food and water.
C) A genetic factor predisposing individuals to H. pylori infection is having type A blood.
D) Person-to-person transmission of the H. pylori organism does not occur.

Ans: B
Chapter: 37
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 3
Patient Needs: A-2
Feedback: A predisposing factor for acquiring H. pylori infection is having type O blood. The organism is endemic to
the United States. Person-to-person transmission is possible through contact with saliva or emesis.

24. The nurse is preparing for a home visit to a patient discharged following a total gastrectomy for treatment of
gastric cancer. The nurse anticipates that the plan of care is most likely to include which of the following nursing
actions?
A) Encouraging the patient to eat small, high-fiber meals at frequent intervals
B) Gastrointestinal decompression by the nasogastric tube
C) Periodic assessment for esophageal distension
D) Monthly administration of injections of vitamin B

Ans: D
Chapter: 37
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 9
Patient Needs: A-1
Feedback: Since vitamin B is absorbed in the stomach, the patient requires vitamin B replacement to prevent
pernicious anemia. The patient who has had a total gastrectomy is likely to require parenteral nutrition. Since the
stomach is absent, a nasogastric tube would not be indicated. Since there is no stomach to act as a reservoir, and
fluids and nutrients are passing directly into the jejunum, distension is unlikely.

25. The distressing symptoms of dumping syndrome result from the occurrence of which of the following physiological
events?
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) Osmotic transport of extracellular fluid into the gastrointestinal tract

Ans: D
Chapter: 37
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 8
Patient Needs: D-4
Feedback: Following gastric surgery, the gastric remnant is anastamosed to the jejunum. When substances high in
carbohydrates and electrolytes are ingested rapidly, they pass directly into the jejunum. Extracellular fluid from the
bloodstream is drawn into the jejunum to dilute these hypertonic intestinal contents. Irritation of the phrenic nerve
causes hiccups. Reflux of bile is an etiologic factor associated with the development of GERD. Patients who have
undergone partial gastrectomy or bariatric surgery may absorb vitamins and minerals less effectively; however, this
change is unrelated to the occurrence of dumping syndrome.