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Unit 4 Exam
Medical-Surgical Nursing
| Question | Answer |
|---|---|
| What is an inflammation of the gastric mucosa? | Gastritis |
| What causes gastritis? | It's the result of a breakdown in the normal gastric mucosal barrier. |
| What drugs can cause gastritis? | NSAIDs, corticosteroids, digoxin, and Fosamax |
| What bacteria is closely associated with gastritis? | Helicobacter pylori |
| What is autoimmune metaplastic atrophic gastritis? | An inherited condition in which there is an immune response directed against parietal cells |
| What fluid and electrolyte imbalances are associated with autoimmune gastritis? | Low chloride levels and pernicious anemia |
| What is a complication of chronic gastritis? | If parietal cells are atrophied, the source of intrinsic factor is lost resulting in pernicious anemia |
| What are the S/S of acute gastritis? | Anorexia, N/V, epigastric tenderness, and a feeling of fullness |
| How is acute gastritis usually diagnosed? | Based on the patient's symptoms and a history of drug or alcohol use |
| What is the main treatment for acute gastritis? | Eliminating the cause and avoiding it in the future |
| What is prescribed if vomiting occurs with acute gastritis? | Rest, NPO status, IV fluids, and antiemetics. NG tube may necessary if vomiting still persists. |
| What are examples of serotonin (5-HT3) antagonists (antiemetics)? | Dolasetron Granisetron Ondansetron (Zofran) Palonosetron |
| What are examples of phenothiazines (antiemetics)? | Chlorpromazine Perphenazine Prochlorperazine Trifluoperazine Promethazine (Phenergan) |
| What are examples of PPIs? | Dexlansoprazole Esomeprazole Lansoprazole Omeprazole Pantoprazole Rabeprazole |
| What are examples of H2 blockers? | Cimetidine Famotidine Nizatidine Ranitidine |
| What does treatment of chronic gastritis focus on? | Evaluating and eliminating the specific cause |
| What diet is recommended with chronic gastritis? | A nonirritating diet consisting of 6 small feedings a day |
| What is peptic ulcer disease (PUD)? | A condition characterized by erosion of the GI mucosa from the digestive action of HCl acid and pepsin |
| How are peptic ulcers classified? | As either acute or chronic |
| What is an acute ulcer associated with? | Superficial erosion and minimal inflammation |
| Do chronic ulcers form fibrous tissue? | Yes |
| Which is more common: An acute or chronic peptic ulcer? | Chronic |
| Where are gastric ulcers predominantly located? | Antrum of stomach |
| How do gastric ulcers affect gastric secretion? | It remains normal or decreases |
| How do duodenal ulcers affect gastric secretion? | Increase it |
| What is the peak age for gastric ulcers? | 50-60 years |
| What is the peak age of duodenal ulcers? | 35-45 years |
| Describe the pain of gastric ulcers. | Burning or gaseous pressure in epigastrium; aggravated by food; begins 1-2 hours after meals |
| Describe the pain of duodenal ulcers. | Burning, cramping across the midepigastrium and upper abdomen; relieved with food and antacids; begins 2-5 hours after meals |
| What chemical does H. pylori produce? | Urease, which increases gastric secretion |
| Why do people of lower socioeconomic status have a higher risk of PUD? | They have a higher prevalence of H. pylori infection |
| What is the main cause of the majority of non-H. pylori peptic ulcers? | Use of NSAIDs |
| What drugs increase the risk of PUD? | Corticosteroids, anticoagulants, SSRIs, and NSAIDs |
| What ulcer has a higher mortality rate: Gastric or duodenal? | Gastric |
| Which type of ulcer accounts for the majority of peptic ulcers? | Duodenal |
| What is Zollinger-Ellison syndrome? | A rare condition characterized by severe peptic ulceration and HCl acid hypersecretion |
| Which patients are more at risk for silent peptic ulcers? | Older adults and those taking NSAIDs |
| What the 3 major complications of PUD? | Hemorrhage, perforation, and gastric outlet obstruction |
| Which ulcers account for more upper GI bleeding: Gastric or duodenal? | Duodenal |
| Which ulcers commonly perforate? | Large penetrating duodenal ulcers |
| What are the clinical manifestations of perforation? | Sudden, severe upper abdominal pain unrelieved by food or antacids; rigid abdomen; shallow, rapid respirations; tachycardia with weak pulse; absent bowel sounds |
| What happens if perforation of an ulcer is left untreated? | Bacterial peritonitis occurs in 6-12 hours |
| What are the clinical manifestations of gastric outlet obstruction? | Pain that is worse at the end of the day; projectile vomiting; constipation; visible abdominal swelling |
| What is the most accurate diagnostic procedure for PUD? | Endoscopy |
| What is used to diagnose H. pylori? | A biopsy of the antral mucosa with testing for urease |
| What's used to diagnose gastric outlet obstruction? | Barium contrast study |
| How long does complete healing of an ulcer take? | 3-9 weeks |
| How long after diagnosis and treatment of PUD is a follow-up endoscopy done? | 3-6 months |
| If aspirin is necessary for a patient with PUD, what other medications are prescribed? | PPI, H2 blocker, or misoprostol (Cytotec). Consider enteric-coated aspirin |
| What is the treatment for appendicitis? | An immediate appendectomy |
| What is inflammatory bowel disease (IBD)? | A chronic inflammation of the GI tract characterized by periods of remission interspersed with periods of exacerbation |
| How is IBD classified? | As either ulcerative colitis or Crohn's disease |
| Which racial groups are most at risk for IBD? | White and Ashkenazic Jewish |
| When does IBD usually occur? | In adolescence and early adulthood with a second peak in the 6th decade |
| True or False: IBD is an autoimmune disease. | True |
| What gene is associated with Crohn's disease? | NOD2 gene |
| What part of the GI tract is most commonly involved with Crohn's disease?D | Distal ileum and proximal colon |
| Does inflammation of Crohn's disease affect all layers of the bowel wall? | Yes |
| True or False: Fistulas are uncommon in active Crohn's disease. | False; Fistulas are common |
| How does ulcerative colitis progress? | It begins in the rectum and moves in a continual fashion toward the cecum |
| Which layer of the intestinal wall does ulcerative colitis affect? | Mucosal layer |
| Are fistulas common with ulcerative colitis? | No |
| What are the S/S of Crohn's disease? | Diarrhea and cramping abdominal pain. Rectal bleeding can occur. |
| What are the primary manifestations of ulcerative colitis? | Bloody diarrhea occurring up to 20 times a day ad abdominal pain |
| What are the GI complications of IBD? | Hemorrhage, strictures, perforation, abscesses, fistulas, CDI (C. diff infection), and toxic megacolon |
| Is toxic megacolon more common with ulcerative colitis or Crohn's disease? | Ulcerative colitis |
| What drugs are used with IBD? | Aminosaliylates, antimicrobials, corticosteroids, immunosuppressants, and biologic & targeted therapy |
| What ulcerative colitis procedure occurs in 2 phases? | Total proctocolectomy with ileal pouch/anal anastomosis (IPAA) |
| What are diverticula? | Saccular outpouchings of the mucosa that develop in the common |
| What is diverticulitis? | Inflammation of one or more diverticula, resulting in perforation into the peritoneum |
| Where are diverticula most common? | The descending and sigmoid colon |
| What is the main contributing factor of diverticulosis? | Lack of dietary fiber intake |
| What is the preferred method of diagnosis of diverticulitis? | CT scan with contrast |
| What is celiac disease? | An autoimmune disease characterized by damage to the small intestinal mucosa from ingesting wheat, barley, and rye |
| Is celiac disease more common in men or women? | Women |
| What are typical S/S of celiac disease? | Foul-smelling diarrhea, steatorrhea, flatulence, abdominal distension, and malnutrition |
| What are atypical S/S of celiac disease? | Osteoporosis, dental enamel hypoplasia, iron and folate deficiencies, peripheral neuropathy, and reproductive problems |
| What are the S/S of diverticulitis? | It can be asymptomatic, but if symptoms occur they include abdominal pain in LLQ, bloating, flatulence, changes in bowel habits, abdominal mass, N/V, and systemic symptoms of infection |
| What is mastitis herpetiformis? | A pruritic, vesicular skin lesion occurring on the buttocks, scalp, elbows, face, and knees; associated with celiac disease |
| How is H. pylori infection treated? | Antibiotic therapy concurrently with PPI for 7-14 days |
| What are the S/S of dumping syndrome? | Generalized weakness, sweating, palpitations, and dizziness |
| How long after eating of S/S of dumping syndrome begin? | 15-30 minutes |
| What is appendicitis? | Inflammation of the appendix |
| What age group is at the highest risk for appendicitis? | 10-30 years old |
| What are systemic complications of IBD? | Joint, eye, mouth, kidney, bone, vascular and skin problems |
| How does appendicitis begin? | With dull periumbilical pain, anorexia, and N/V |
| How does pain at the beginning of appendicitis change? | Shifts to RLQ and localizing at Murphey's point |
| What is the preferred method of diagnosis for appendicitis? | CT scan |
| Are PPIs or H2 blockers more effective for ulcer healing? | PPIs |
| Why is misoprostol (Cytotec) prescribed with PUD? | To prevent gastric ulcers caused by NSAIDs and aspirin |
| What antibiotics are prescribed after perforation of an ulcer? | Broad-spectrum to treat bacterial peritonitis |
| What type of ulcer is most likely to cause gastric outlet obstruction? | A gastric ulcer close to the pylorus |
| What is dumping syndrome? | The direct result of surgical removal of a large portion of the stomach and pyloric sphincter |
| What is the only effective treatment for celiac disease? | A gluten-free diet |
| What cancers are more common in patients with celiac disease? | Non-Hodgkin's lymphoma and GI cancers |
| What are S/S of lactose intolerance? | Bloating, flatulence, cramping abdominal pain, and diarrhea after ingesting a milk product |
| What is irritable bowel syndrome (IBS)? | A disorder characterized by chronic abdominal pain or discomfort and alteration of bowel patterns |
| True or False: IBS has no known organic cause? | True |
| How is IBS diagnosed? | Solely on patient's symptoms |
Created by:
shrewsburysd
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