Med surg chapter 33

The nurse is caring for a patient with gastroesophageal reflux disease (GERD). Which patient statement indicates a need for nutritional instruction? a. I should drink milk, as it is the perfect food. b. Nutrition can affect health positively or negatively. c. Excessive intake of a nutrient can interfere with others. d. Classes of nutrients are carbohydrates, fats, proteins, vitamins, minerals, and water.

ANS: A A low-fat, high-protein diet is recommended because fat causes decreased functioning of the lower esophageal sphincter. Caffeine, milk products, and spicy foods should be avoided. B. C. D. These patient statements are appropriate for the patient with gastroesophageal reflux disease.

The nurse is caring for a patient recovering from radical neck dissection for cancer and tracheostomy placement. What action by the nurse should take priority? a. Ensuring airway patency b. Ensuring adequate nutrition c. Teaching about smoking cessation d. Establishing ways of communication

ANS: A A tracheostomy is usually performed to protect the airway and prevent obstruction. The airway must be monitored and secretions controlled to prevent aspiration. B. C. D. These actions are important however do not take the priority over maintaining a patent airway.

The nurse teaching a patient with gastroesophageal reflux about the influence of body position on the disease process. Which patient statement indicates that teaching has been effective? a. I elevate the head of the bed 4 to 6 inches. b. I elevate the foot of the bed 12 to 16 inches. c. I sleep on my back without a pillow under my head. d. I sleep on my stomach with my head turned to the left.

ANS: A Elevating the head of the bed 4 to 6 inches helps prevent reflux of gastric contents into the esophagus. B. The head of the bed does not need to be elevated 12 to 16 inches. C. D. Sleeping flat or on the stomach could exacerbate symptoms of gastroesophageal reflux.

A patient is recovering from a Billroth I procedure and has a nasogastric Levin tube set to low intermittent suction. As the patient turns in bed, the Levin tube is partially pulled out. Which action should the nurse take? a. Notify the registered nurse (RN). b. Irrigate the tube. c. Advance the tube. d. Place suction on continuous.

ANS: A The nurse needs to inform the RN or physician because the tube will need to be repositioned. The physician typically is the one that does the repositioning after gastric surgery so the suture line is not affected. B. C. D. The nurse should not irrigate the tube, advance the tube, or place the tube on continuous suction since these actions could injure the suture line.

The nurse is teaching a patient about gastric surgery and dumping syndrome. Which statement indicates that the patient understands dumping syndrome? a. I need to eat small frequent meals. b. I should drink lots of fluids with meals. c. I need to sit up for 2 hours after each meal. d. I can expect the symptoms to begin 2 hours after eating.

ANS: A Treatment for dumping syndrome includes teaching the patient to eat small, frequent meals that are high in protein and fat and low in carbohydrates, especially refined sugars. B. The patient should be taught to avoid fluids 1 hour before meals, with meals, or for 2 hours after meals to prevent rapid gastric emptying. C. It is best for the patient to lie down after meals to delay gastric emptying. D. The symptoms occur 5 to 30 minutes after eating.

The nurse is caring for a patient on a gastrointestinal unit. Which patient statement should cause the nurse the most concern? a. My stool has been dark green and hard to pass lately. b. Lately, Ive had two or three loose, sticky black stools every day. c. Usually I move my bowels every day and the stool is light brown. d. My stool is soft and dark brown; I usually move my bowels twice a day.

ANS: B The nurse should be most concerned if there were evidence of blood loss causing black tarry stools (melena). A. Stool that is dark green and hard to pass could indicate constipation caused by an iron preparation. C. D. More information is needed before becoming concerned about these descriptions.

A patient with a hiatal hernia is experiencing heartburn. Which should the nurse suggest to this patient? a. Eat large meals. b. Avoid bedtime snacks. c. Sleep flat without a pillow. d. Recline 1 hour before meals.

ANS: B Treatment for hiatal hernia includes avoiding bedtime snacks. A. Small meals that pass easily through the esophagus should be eaten. C. The head of the bed should be elevated 6 to 12 inches to prevent reflux. D. Reclining for 1 hour after eating should be avoided.

The nurse is reinforcing teaching with a patient who had a large portion of the stomach removed. Which patient statement indicates understanding of why the patient will need to receive vitamin B12 for life? a. Sickle cell anemia b. Pernicious anemia c. Iron-deficiency anemia d. Acquired hemolytic anemia

ANS: B Vitamin B12 deficiency can occur after some or all of the stomach is removed because intrinsic factor secretion is reduced or gone. Normally, vitamin B12 combines with intrinsic factor to prevent its digestion in the stomach and promote its absorption in the intestines. Lifelong administration of vitamin B12 is required to prevent the development of pernicious anemia. A. C. D. Removal of part of the stomach will not lead to the development of sickle cell anemia, iron-deficiency anemia, or acquired hemolytic anemia.

A patient with a duodenal peptic ulcer vomits old blood. What description should the nurse use to document the appearance of the vomitus? a. Duodenal fecal matter b. Coffee-ground particles c. Undigested particles of food d. Chyme streaked with a black syrupy material

ANS: B When blood mixes with hydrochloric acid and enzymes in the stomach, a dark, granular material resembling coffee grounds is produced. This indicates old bleeding, as fresh bleeding would be red in color. A.C. D. The nurse should not document the appearance of the patients emesis as being duodenal fecal matter, undigested food particles or a chyme mixture.

The nurse is caring for a patient with a sliding hiatal hernia. In which position should the nurse expect the patient to report that the symptoms are more acute? a. Sitting b. Standing c. Lying down d. Semi-Fowlers

ANS: C In a sliding hiatal hernia, the stomach slides up into the thoracic cavity when a patient is supine and then goes back into the abdominal cavity when upright. Sliding hiatal hernia symptoms are worse when lying down. A. B. D. The symptoms of a hiatal hernia are not worse when sitting, standing, or in the semi-Fowlers position.

The nurse is reinforcing teaching provided to a patient with a hiatal hernia. Which patient statement indicates a correct understanding of lifestyle modification to reduce symptoms? a. Avoid high-stress situations. b. Perform daily aerobic exercise. c. Avoid nicotine and alcohol use. d. Carefully space activity periods with rest.

ANS: C Lifestyle changes for symptomatic hiatal hernia include losing weight, antacids, eating small meals that pass easily through the esophagus, not reclining for 3-4 hours after eating, elevating the head of the bed 6 to 12 inches to prevent reflux, and avoiding bedtime snacks, spicy foods, alcohol, caffeine, and smoking. A. B. D. Stress, exercise, and rest periods are not recommendations for the patient with a hiatal hernia.

The nurse is caring for a patient with a vented nasogastric tube ordered to suction after a gastrectomy. What type of suction should the nurse use to decrease the development of complications? a. Continuous low suction b. Continuous high suction c. Intermittent low suction d. Intermittent high suction

ANS: C With a physicians order, the nasogastric tube is connected to suction equipment, usually set on low intermittent suction if the secretions are not too thick, to prevent injury to the gastric mucosa. The vent also helps prevent this injury. A. B. D. These settings for suction might cause injury to the gastric mucosa.

The nurse is providing care to a patient 3 days after a Billroth I procedure. About which observation should the nurse be most concerned? a. Pulse 58 beats per minute b. Incisional pain score 4 on a 1 to 10 scale c. Patient becomes tearful while viewing the incision d. Reports of abdominal cramping shortly after eating

ANS: D Dumping syndrome is a complication of Billroth I procedure and occurs 5 to 30 minutes after eating. Symptoms include dizziness, tachycardia, fainting, sweating, nausea, diarrhea, a feeling of fullness, and abdominal cramping. A. A pulse of 58 beats per minute could be within the patients normal pulse range. B. C. Pain and the emotional reaction to the incision are psychosocial concerns and are not the highest priority at this time.

A patient with a nasogastric tube to low intermittent suction after surgery begins to vomit bright red blood. Which action should the nurse take first? a. Administer oxygen. b. Irrigate the nasogastric tube. c. Increase the intravenous rate. d. Turn the patient onto his or her side.

ANS: D Protection of the airway during vomiting is a priority to prevent aspiration. Those at risk of aspiration are persons who are unconscious, older, and experiencing gag reflex impairments. Place these types of persons on their side when they begin to vomit. This allows the gastric contents to be expelled from the mouth rather than pooling at the back of the throat and being aspirated. A. The patient does not necessarily need oxygen at this time. B. The patient could aspirate while the nurse is irrigating the nasogastric tube. C. There is no reason to increase the patients intravenous infusion at this time.

The nurse is reinforcing teaching provided to a patient scheduled for pyloroplasty. Which patient statement indicates a correct understanding of the procedure? a. The doctor will stitch the top of my stomach to help me lose weight. b. The doctor will cut the nerve that goes to my stomach so less acid is released. c. The pylorus will be narrowed to prevent gastric reflux and help my ulcers heal. d. The surgery will improve the movement of food from my stomach to my small intestine.

ANS: D Pyloroplasty widens the exit of the pylorus to improve emptying of the stomach. A. Suturing part of the stomach is part of Bariatric surgery. B. Cutting the nerve to the stomach is a vagotomy. C. There is no surgery to narrow the pylorus.