GI Pharm Practice Questions
The nurse is doing triage at the community clinic when a middle-aged patient presents with abdominal pains and heartburn. The patient states the symptoms have persisted for several days following a particularly spicy meal. When assessing the patient, the nurse notes the patient has a history of acute gastritis. What complication 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 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 would not be an expected finding for a patient who has ingested a corrosive substance.
All postoperative patients are at risk for complications. In addition to these complications, what are patients undergoing gastric surgery at increased risk for? A) Dietary excess B) Bile obstruction C) Decreased intestinal motility D) Hemorrhage
ANS: D In addition to the complications to which all postoperative patients are subject, the patient undergoing gastric surgery is at increased risk for hemorrhage, dietary deficiencies, bile reflux, and dumping syndrome. These patients are not at increased risk for dietary excess, bile obstruction, or decreased intestinal motility.
A patient has been brought to the emergency department with an arm injury. It is found that the patient has fractured the radius and may require surgery. The patient's last meal was at 6:00 PM, and the surgery is held for risk of a potential aspiration. What is the earliest time the patient could potentially have surgery? A) 12:00 AM B) 9:00 PM C) 8:00 AM D) 6:00 AM
ANS: A Within four of eating, residual waste material passes into the terminal ileum. Therefore options B, C, and D are incorrect.
You are caring for a patient who has a diagnosis of GI bleed. When you make your shift assessment, you find the patient is tachycardic and hypotensive. The patient has an episode of hematemesis while you are in the room. What would be a priority nursing action for this patient? A) Put them in a high Fowler's position. B) Give them ice water. C) Assess for pain. D) Notify the physician.
ANS: D 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 patient's vital signs are monitored as the patient's condition warrants. Putting the patient in a high Fowler's position is not a priority and neither is assessing for pain. Giving them ice water is contraindicated as it would stimulate more vomiting.
A patient comes to the clinic for a routine checkup. During the assessment the patient states that they have had pain in the mid-epigastric region off and on for "several weeks." The nurse suspects a peptic ulcer and asks the patient to describe their pain. A patient with a peptic ulcer usually describes the pain as what? A) Gnawing B) Sharp stabbing C) Overdistended feeling D) Cramping or aching
ANS: A Patients with ulcers generally describe the pain as a gnawing or dull pain. They may also complain of a burning sensation. Patients do not generally describe their pain as "sharp stabbing," an "overdistended feeling," or as "cramping or aching."
A patient presents to the walk-in clinic complaining of vomiting and burning in their mid-epigastria. The nurse knows that to confirm 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) Gastric irritation caused by NSAIDs D) Over-consumption of spicy foods
ANS: A 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. Other less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test. 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.
A patient has just been diagnosed with gastric cancer. The nurse is taking a history on this patient. What would be an important question to ask? A) What is the patient's smoking and alcohol history? B) What is the patient's work history? C) What is the patient's level of fatigue? D) What is the family history of smoking and alcohol use?
ANS: A Other health information to obtain includes the patient's smoking and alcohol history and family history (eg, any first- or second-degree relatives with gastric or other cancer). The patient's work history would not be a question asked at this time, and neither would the family history of alcohol and tobacco use. The patient's level of fatigue is not a question asked when taking a history
A patient has come to the clinic complaining of pain just above her umbilicus. When assessing the patient, the nurse notes Sister Mary Joseph's nodules. The nurse knows that this is a sign of what? A) A GI malignancy B) Dumping syndrome C) Peptic ulcer disease D) Esophageal/gastric obstruction
ANS: A Palpable nodules around the umbilicus, called Sister Mary Joseph's 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.
What is the Zollinger-Ellison syndrome? A) Severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas B) Gastrin-secreting tumors of the duodenum, extreme gastric hypoacidity, and severe peptic ulcers C) Malignant tumors of the pancreas, severe peptic ulcers, extreme gastric hyperacidity D) Severe peptic ulcers, extreme gastric hypoacidity, and gastrin-secreting benign tumors of the pancreas
ANS: A Peptic ulcers are found in rare cases in patients with tumors that cause secretion of excessive amounts of the hormone gastrin. The Zollinger-Ellison syndrome (ZES) consists of severe peptic ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or malignant tumors of the pancreas. This makes options B, C and D incorrect.
A nurse in the Postanesthesia Care Unit admits a patient following resection of a gastric tumor. The patient should be placed in which position to facilitate both patient comfort and gastric emptying? A) Semi-Fowler's B) Dorsal recumbent C) Side-lying D) Left Simm's
ANS: A Positioning the patient in a Fowler's 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.
A patient who experienced a gastric hemorrhage has had the bleeding controlled. The patient's condition is now stable. The nurse caring for this patient should have as her priority frequent assessment of the patient for what? A) Tachycardia, hypotension, and tachypnea B) Tarry, foul-smelling stools C) "Coffee ground" material in nasogastric tube drainage D) Irritation of the nares and nasal mucosa
ANS: A 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
A patient comes to the clinic complaining of pain in the epigastric region. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by what? A) Eating B) Drinking milk C) Suppressing emesis D) Having a bowel movement
ANS: A Taking antacids, eating, or vomiting often relieves the pain. Pain occurs about 2 hours after eating. Milk is contraindicated in relieving peptic ulcer pain.
The dietitian is giving an inservice to the nurses on your unit. Many of your elderly patients experience poor wound healing after surgery. The dietitian has determined that these patients require more protein in their diet. The nurses are aware that enzymes are essential in the digestion of nutrients. What is the enzyme that initiates the digestion of protein? A) Pepsin B) Intrinsic factor C) Lipase D) Amylase
ANS: A The enzyme that initiates the digestion of protein is pepsin. Intrinsic factor combines with vitamin B12 for absorption by the ileum. Amylase aids in the digestion of starch, and lipase aids in the digestion of fats.
You are doing patient teaching with a patient has just been prescribed Prevacid. What statement 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 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.
The nurse is caring for a patient who is scheduled for a colonoscopy. The nurse is preparing to instruct the patient on a colon preparation procedure that will include polyethylene glycol electrolyte lavage prior to the procedure. What is the nurse aware of about the use of lavage solutions and when they are contraindicated? A) In a patient with an inflammatory bowel disease B) In a patient with polyps C) In a patient with a colostomy D) In a patient with colon cancer
ANS: A The use of a lavage solution is contraindicated in patients with intestinal obstruction or inflammatory bowel disease. Patients with a colostomy can receive a lavage solution. Cleansing of the colon using polyethylene glycol electrolyte lavage is a common procedure that precedes a colonoscopy, as a colonoscopy is the most frequently used diagnostic aid and screening device for patients with previous colon cancer or polyps.
Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. It is an abdominal catastrophe and requires immediate surgery. Penetration is erosion of the ulcer through the gastric serosa into adjacent structures such as the pancreas, biliary tract, or gastrohepatic omentum. What are the signs and symptoms of perforation? (Mark all that apply.) A) Collapse B) Hypertension C) Pain referred to the right shoulder D) Vomiting E) Bradycardia
ANS: A, C, D Signs and symptoms of perforation include the following: sudden, severe upper abdominal pain (persisting and increasing in intensity); pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm; vomiting; collapse (fainting); extremely tender and rigid (boardlike) abdomen; and hypotension and tachycardia, indicating shock.
The nurse is caring for a patient who has been diagnosed with a peptic ulcer. The patient asks the nurse what a peptic ulcer is. 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) Viral invasion of the stomach wall
ANS: B A peptic ulcer is erosion of the lining of the stomach or intestine. It is not inflammation, bleeding, or a viral invasion of the stomach wall.
The nurse is assessing a patient on antibiotic therapy for gastritis. 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) 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 Acute gastritis is often caused by dietary indiscretion—a person eats food that is irritating, too highly seasoned, or contaminated with disease-causing microorganisms. 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.
A 75-year-old Hispanic male is brought to the clinic by his daughter, who tells the nurse she doesn't know what is wrong with her father. The daughter states her father is confused, agitated, and restless and has been for several weeks. What is one diagnosis the nurse should suspect? A) Duodenal ulcers B) Gastric cancer C) Peptic ulcers D) Chronic gastritis
ANS: B Confusion, agitation, and restlessness may be the only symptoms seen in elderly patients, who may have no gastric symptoms until their tumors are well advanced. These are not generally symptoms of duodenal or peptic ulcers, which present with pain. These are also not generally symptoms of chronic gastritis.
The nurse caring for a patient who has had bariatric surgery is developing a teaching plan for his patient. Which information listed below is essential to include? A) Drink a minimum of 90 mL of fluid with each meal. B) Eat six 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 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.
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) 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 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 client's 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.
The nurse is caring for a patient who has just returned from the PACU after having surgery for peptic ulcer disease. What potential complication does the nurse know to monitor for? A) Decreased appetite B) Pyloric obstruction C) Increased salivation D) Inability to clear secretions
ANS: B Potential complications may include the following: hemorrhage, perforation, penetration, and pyloric obstruction (gastric outlet obstruction). A patient who has had surgery for peptic ulcer disease may have a decreased appetite in the immediate postoperative stage, but it is not something the nurse would monitor for. Increased salivation and inability to clear secretions are generally not complications of peptic ulcer surgery.
An important part of the nurse's assessment of the patient with peptic ulcer disease is assessing the patient's level of anxiety. How is this accomplished? A) Appropriate information is provided to the patient's family. B) Patient is encouraged to express fears openly. C) Some patients aren't anxious so this assessment isn't necessary. D) Information is given in written form.
ANS: B The nurse assesses the patient's level of anxiety. Patients with peptic ulcers are usually anxious, but their anxiety is not always obvious. Appropriate information is provided at the patient's level of understanding, all questions are answered, and the patient is encouraged to express fears openly.
A 30-year-old obese female patient who underwent gastric banding 3 days ago is getting ready to go home. Essential postoperative teaching for this client should include instruction related to the importance of abstaining from what for the next 2 years? A) Multivitamin supplements B) Pregnancy C) Antidepressants D) Control top panty hose
ANS: B 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 client 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.
What are the complications that can occur following gastric surgery? (Mark all that apply.) A) Dumping syndrome B) Stomal ulcers C) Pneumonia D) Metabolic imbalances E) Gastritis
ANS: B, C, D Complications that may occur in the immediate postoperative period include peritonitis, stomal obstruction, stomal ulcers, atelectasis and pneumonia, thromboembolism, and metabolic imbalances resulting from prolonged vomiting and diarrhea or altered gastrointestinal function. Dumping syndrome does not generally occur in the immediate postoperative period, and neither does gastritis.
A nurse is preparing to discharge a patient 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 or gains weight. D) The patient consumes a diet high in calcium.
ANS: C Expected outcomes for the patient following gastric surgery include daily weights to ensure that the patient is maintaining or gaining weight, 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.
The PACU nurse calls report to the receiving nurse regarding a patient who is returning to the unit after a Billroth II (gastrojejunostomy). What complication will the receiving nurse assess this patient for related to this procedure? A) Feelings of hunger B) Constipation C) Feeling of fullness D) Gastric reflux
ANS: C 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.
When preparing a patient who has had gastric surgery to go home, what information is given to the patient, significant other, and family? A) Location of local senior center B) Locations of elder care facilities C) End-of-life care, when indicated D) Contact number for Meals-on-Wheels
ANS: C Information about community support groups and end-of-life care is provided to the patient, family, or significant other when indicated. The location of the local senior center, elder care facilities, or the contact number for Meals-on-Wheels would probably not be appropriate for all patients as many are under the age of 55.
The nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The patient has been newly prescribed misoprostol (Cytotec). What would the nurse be most accurate in informing the patient about 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 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).
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 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 on a daily basis. Protein drinks do not result in gastric inflammation
What bariatric surgical procedure is recommended for long-term weight loss? A) Gastric banding B) Vertical-banded gastroplasty C) Roux-en-Y D) Biliopancreatic diversion
ANS: C The Roux-en-Y gastric bypass is recommended for long-term weight loss. It is a combined restrictive and malabsorptive procedure. Therefore options A, B, and D are incorrect.
A patient you are caring for is going to have gastric surgery in the morning. It is important for you to assess the patient's nutritional status as well as assessing for the presence of bowel sounds. Why would you palpate the abdomen? A) To assess for Sister Joseph's nodule B) To assess for appendicitis C) To detect masses D) To detect rigidity
ANS: C The nurse assesses for the presence of bowel sounds and palpates the abdomen to detect masses or tenderness. The scenario does not indicate the patient has cancer, so the nurse would not be assessing for Sister Joseph's nodule. It would not be necessary to assess for appendicitis on a patient scheduled for gastric surgery. Rigidity of the abdomen is an indication of an emergent condition requiring surgery; you would not assess for rigidity in a patient already scheduled for gastric surgery.
You are writing a plan of care for a patient newly diagnosed with gastric cancer. What would the major goals for this patient include? (Mark all that apply.) A) Eat three nourishing meals daily B) Maintain adequate psychosocial support C) Relief of pain D) Adjustment to the diagnosis E) Reduced anxiety
ANS: C, D, E The major goals for the patient may include reduced anxiety, optimal nutrition, relief of pain, and adjustment to the diagnosis and anticipated lifestyle changes. Major goals would not include eating three meals a day or maintaining adequate psychosocial support.
A patient with a peptic ulcer has asked the nurse for help in selecting their dinner menu. Which beverage would be most appropriate for this patient? A) Vanilla milkshake B) Decaffeinated coffee C) Unsweetened iced tea D) Room-temperature grape juice
ANS: D Coffee and tea, whether caffeinated or decaffeinated, stimulate gastric acid secretion. The same is true of foods rich in milk and cream. Over-secretion of acid and hypermotility of the GI tract can be decreased by avoiding extremes of temperature in food and beverages.
What is currently the most commonly used therapy for peptic ulcers? A) Bismuth salts, antibiotics, and histamine-2 antagonists B) H2 antagonists, antibiotics, and bicarbonate salts C) Bicarbonate salts, antibiotics, and ZES D) Antibiotics, proton pump inhibitors, and bismuth salts
ANS: D 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; proton pump inhibitors are. Bicarbonate salts are not used. ZES is the Zollinger-Ellison syndrome and not a drug.
A patient asks the Home Health Nurse what the distressing symptoms of dumping syndrome result from? What physiologic occurrence would the nurse explain? 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 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.
A patient has just been diagnosed with acute gastritis. What would be the nursing care needed by this patient? A) Teaching regarding nutrition B) Advising the patient not to smoke C) Recommending bed rest D) Physical and emotional support
ANS: D 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. Nursing care of this patient would not include teaching regarding nutrition or smoking at this time. Also, the nurse would not recommend bed rest.
While caring for a patient hospitalized with chronic gastritis it is important to educate the patient about what? A) How to eat nutritiously B) The correct use of medications to relieve acute gastritis C) How to position themselves to relieve pain D) Avoiding irritating foods and beverages
ANS: D 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. Education for chronic gastritis does not routinely include how to eat nutritiously or positioning themselves to relieve pain. Since the patient has chronic gastritis, option B is incorrect.
The Home 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) Encouraging the patient to eat small, high-fiber meals at frequent intervals B) Gastrointestinal decompression by nasogastric tube C) Periodic assessment for esophageal distension D) Monthly administration of injections of vitamin B
ANS: D 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.
The nurse is admitting a patient diagnosed with gastric cancer. The nurse is concerned that the patient's gastric cancer is progressing when the nurse assesses which symptom? A) Stomach pain relieved with antacids B) Anemia C) Diarrhea D) Bloating after meals
ANS: D 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 dyspepsia (indigestion), early satiety, weight loss, abdominal pain just above the umbilicus, loss or decrease in appetite, bloating after meals, nausea and vomiting, and symptoms similar to those of peptic ulcer disease.
A team approach is the best approach to discharge planning for a patient who has had gastric surgery. What is helpful to the patient and family to reinforce discharge teaching? A) Home health nurse re-teaching material in patient's home B) Scheduled visits from speech therapist C) Scheduled phone calls from social worker D) Video instructions about meals and activities
ANS: D Written or video instructions about meals, activities, medications, and follow-up care are helpful. The home health nurse may or may not be involved in this patient's care if the patient is not on tube feedings. A speech therapist is not necessary in gastric surgery. The social worker would schedule visits, if necessary, not phone calls.
