Unit 4 - Review
The nurse is caring for a patient with anorexia, nausea, vomiting, epigastric pain, and feeling of fullness. Which interventions are beneficial to the patient? Select all that apply. 1 Inserting a nasogastric tube 2 Administering intravenous fluids 3 Maintaining the patient on nothing-by-mouth (NPO) status 4 Educating the patient that fainting may occur due to cimetidine 5 Providing the patient with nonirritating diet consisting of six small feedings a day
1 2 3 Anorexia, nausea, vomiting, epigastric pain, and a feeling of fullness are the symptoms of acute gastritis. Therefore, a nasogastric tube should be inserted to irrigate the precipitating agent from the stomach, to monitor bleeding, and to keep the stomach free from noxious smell. Administration of intravenous fluids may compensate for fluid loss in patients due to vomiting. The patient with acute gastritis should be kept on nothing-by-mouth (NPO) status to prevent vomiting. Drug therapy for gastritis includes H2-receptor blockers (ranitidine, cimetidine) and proton pump inhibitors (lansaprazole, omiprazole). The nurse should inform the patient about the therapeutic effects of the medications. Cimetidine is an H2-receptor blocker that causes headache, abdominal pain, constipation, and diarrhea; it is not associated with fainting. Providing a nonirritating diet consisting of six small feedings per day is helpful for patients with chronic gastritis. Text Reference - p. 942
A nurse is teaching an obese patient with gastroesophageal reflux disease (GERD) measures that should be taken to prevent complications. What instructions should the nurse give? Select all that apply. 1 Maintain a low-fat diet. 2 Avoid smoking cigarettes. 3 Use anticholinergic drugs, as prescribed. 4 Avoid tea and coffee. 5 Lie down immediately after having food
1 2 4 In an obese person, the intraabdominal pressure is increased, which can exacerbate GERD. Maintaining a low-fat diet could help in losing weight and therefore relieve the condition. Tea, coffee, and nicotine (a component of cigarettes) are known to decrease the lower esophageal sphincter pressure, aggravating GERD. Patients with GERD are prescribed cholinergic drugs to relieve their condition. Anticholinergic drugs, on the other hand, affect the lower esophageal sphincter pressure and may therefore cause GERD. Lying down immediately after eating food may promote the movement of food toward the esophageal sphincter and increase the pressure on it, therefore exacerbating the condition. Text Reference - p. 933
A nurse is teaching a patient about prevention of peptic ulcers. What instructions should the nurse give the patient? Select all that apply. 1 Avoid smoking. 2 Consume raw uncooked food. 3 Use nonsteroidal antiinflammatory drugs (NSAIDs) for treatment of pain. 4 Wash hands thoroughly with soap after using the restroom and before eating. 5 Report symptoms of gastric irritation, such as nausea and epigastric pain, to the health care provider.
1 4 5 Nicotine, a component of cigarettes, causes gastric irritation, and therefore smoking should be avoided by those with peptic ulcers. Washing hands thoroughly with soap after using the restroom and before eating would help prevent the Helicobacter pylori infection that causes peptic ulcers. Any symptom of gastric irritation such as nausea and epigastric pain must be reported to the health care provider to prevent lethal consequences of peptic ulcer disease. Consumption of raw uncooked food increases the chance of H. pylori infection; therefore, it should be avoided. NSAIDs should not be taken over a long period of time, because they are a potent gastric irritant. Text Reference - p. 946
The nurse is teaching care management to a patient with gastroesophageal reflux disease (GERD). In the follow-up visit, the patient complains of severe heartburn. Which actions indicate the need for further teaching? Select all that apply. 1 The patient eats oranges daily. 2 The patient drinks 2 L of water daily. 3 The patient chews gum daily. 4 The patient eats ice cream often. 5 The patient eats ginger daily. 6 The patient drinks a cup of milk at bedtime.
1 4 6 Oranges are a source of citric acid. Eating acidic foods aggravates the symptoms of gastroesophageal reflux disease (GERD). Ice cream is rich in fatty acids. Fats tend to decrease lower esophageal sphincter (LES) pressure, resulting in regurgitation of stomach acid. Drinking a cup of milk at bedtime increases gastric acid secretion. Therefore, the nurse recommends that the patient avoid oranges, ice cream, and milk. Drinking 2 L of water neutralizes the pH of stomach acid and reduces the symptoms of GERD. Chewing gum increases the production of saliva, thereby helping neutralize the pH of gastric acid. Ginger is known for its antiinflammatory and antacid activities. Text Reference - p. 933
The nurse is preparing a care plan for a patient who underwent an open high abdominal incision. Which necessary interventions should the nurse include in the care plan? Select all that apply. 1 Monitoring pulse rate 2 Monitoring bowel sounds 3 Monitoring blood glucose 4 Monitoring respiratory rate 5 Monitoring serum creatinine
1 4 After an open high abdominal incision, respiratory complications can occur. Therefore, the nurse should monitor pulse rate and respiratory rate. Bowel sounds and blood glucose level are not altered after an open high abdominal incision. Serum creatinine levels are altered in kidney and liver diseases but not after an open high abdominal incision. Text Reference
The nurse is interviewing a patient with a duodenal ulcer. Which characteristic of pain is the nurse likely to find? 1 The pain is cramp like. 2 The pain occurs one to two hours after a meal. 3 The pain is located high up in the epigastrium. 4 The pain is aggravated by food intake.
1 The pain related to a duodenal ulcer is cramp-like, burning, back pain and appears 2 - 4 hours after a meal. The pain is located in the midepigastric region beneath the xiphoid process & back. *The pain is relieved by food intake.* Text Reference -
Which dietary instructions should the nurse provide the caregiver of a postoperative patient with dumping syndrome? Select all that apply. 1 "Avoid giving cheese." 2 "Give the patient eggs and meat." 3 "Avoid giving jelly and jam." 4 "Avoid giving fluids with meals." 5 "Divide the meals into three feedings
2 3 4 Eggs and meat contain proteins and fat, which help to rebuild body tissues and meet energy demands. Cheese contains proteins and fats and should be provided to the patient. Distention and fullness of the stomach can occur if fluids are consumed along with meals. Jelly and jam cause diarrhea and dizziness; these foods should be avoided. The meals of the patient should be divided into six small feedings to avoid overloading the stomach and intestine during meal times. DUMPING: Increase Protein; Decrease Carbs 6 Small meals Avoid Fluids with meals Avoid Concentrated Sugars Lie down after meal
The nurse is caring for a patient with a hiatal hernia. Which instructions should the nurse include teaching? Select all that apply. 1 "You may drink soda." 2 "You should avoid caffeine." 3 "You should avoid chocolate." 4 "You should suck peppermint." 5 "You should drink orange juice
2 3 Caffeine and chocolate are reflux-inducing foods that irritate the esophagus or weaken the lower esophageal sphincter causing backward flow of stomach contents. Therefore, caffeine and chocolate should be avoided in patients with a hiatal hernia. Soda is acidic and should be avoided in patients with a hiatal hernia. Peppermint is a reflux-inducing food and should be avoided. Acidic pH beverages such as orange juice should also be avoided by patients with a hiatal hernia. Text Reference - p. 936
After assessing a patient with gastrointestinal bleeding, the nurse suspects shock in the patient. Which findings in the patient support the nurse's conclusion? Select all that apply. 1 Dry skin 2 Increased thirst 3 Rapid, weak pulse 4 High blood pressure 5 Increased temperature
2 3 Shock is a life-threatening condition involving low blood perfusion to the tissues. The circulatory volume is reduced during shock, resulting in the release of antidiuretic hormone (ADH). This helps to increase the renal reabsorption, thereby increasing the blood volume. As a result, thirst is increased. The patient has a rapid, weak pulse due to a low oxygen supply to the tissues. The patient with shock has clammy skin, low blood pressure, and a temperature lower than the normal body temperature. Text Reference - p. 956
A postmenopausal patient complains of back pain and burning pain in midepigastric region three hours after a meal. The medical history of the patient reveals hyperparathyroidism. Which condition does the nurse suspect in the patient? 1 Gastric ulcer 2 Duodenal ulcer 3 Zollinger-Ellison syndrome 4 Postprandial hypoglycemia
2 Back pain and burning pain in the midepigastric region two to five hours after eating indicate a duodenal ulcer. - - These ulcers are more common in MEN but increasingly occur in postmenopausal women. - - They are associated with disease conditions such as renal failure, pancreatitis, hyperparathyroidism, and chronic obstructive pulmonary disease. Gastric ulcers are characterized by burning pain in the left epigastrium and upper abdomen. Zollinger-Ellison syndrome is a condition that involves severe peptic ulceration and hydrochloric acid secretion. Postprandial hypoglycemia is a postoperative complication of gastrectomy that occurs two hours after eating. Symptoms include sweating, weakness, confusion, palpitations, anxiety, and tachycardia. Text Reference - p. 944
Which medication increases lower esophageal sphincter pressure? 1 Diazepam 2 Bethanechol 3 Theophylline 4 Morphine sulfate
2 Bethanechol is a cholinergic - increases the pressure in the lower esophagus. Diazepam, theophylline, and morphine sulfate are medications that decrease lower esophageal pressure.
Which intervention should the nurse perform when finding that a postgastrectomy patient has greenish yellow discharge eight hours after insertion of a nasogastric tube? 1 Remove the nasogastric tube. 2 Document it as a normal finding. 3 Notify the primary health care provider. 4 Place the patient in a semi-Fowler's position
2 Discharge of bloody, greenish to yellow drainage from the nasogastric tube for 8 to 12 hours after insertion is a common observation. Therefore, the nurse should document it as a normal finding. The nurse should not remove the nasogastric tube without consulting the primary health care provider. Notifying the primary health care provider is not necessary, because discharge of bloody drainage is a normal finding. Placing the patient in a semi-Fowler's position will help prevent the risk of aspiration; however, it will not reduce the drainage from the nasogastric tube.
The postoperative patient states that he or she has never taken pantoprozole in the past. The patient asks why he or she is getting this medication if the patient has never had heartburn. What is the best response by the nurse? 1 "The stress of surgery is likely to cause stomach bleeding if you do not receive it." 2 "This will reduce the amount of acid in your stomach until you can eat a regular diet again." 3 "This will prevent the heartburn that occurs as a side effect of your diabetes." 4 "This will prevent gas pains from the excess air in your small intestine."
2 Pantoprazole is a proton-pump inhibitor which decreases acid production in the stomach. It minimizes damage to the gastric mucosa while the patient is on bed rest and hospitalized after surgery. Pantoprazole will not prevent gas pains and will not prevent stomach bleeding from surgery. Heartburn is not a side effect of diabetes. Text Reference - p. 934
Which medication is prescribed for cytoprotective drug therapy? 1 Tofranil 2 Sucralfate 3 Cimetidine 4 Misoprostol
2 (Sucralfate provides cytoprotective for the esophagus, stomach, and duodenum by forming a protective layer and serves as a barrier against acids, bile salts, and enzymes. Tofranil is a tricyclic antidepressant that provides pain relief in peptic ulcer disease. Cimetidine is a histamine blocker that provides ulcer healing. Misoprostol is prescribed to prevent gastric ulcers caused by nonsteroidal antiinflammatory drugs.)
Regurgitation is defined as: 1 A forceful expulsion of stomach contents without nausea 2 A feeling of discomfort in the epigastrium with a conscious desire to vomit 3 An effortless process in which partially digested food slowly comes up from the stomach 4 Involuntary wavelike movements occurring within the alimentary canal that force contents onward
3 An effortless process in which partially digested food slowly comes up from the stomach is the definition of regurgitation. A forceful expulsion of stomach contents without nausea is the definition of projectile vomiting. The feeling of discomfort in the epigastrium with a conscious desire to vomit is the definition of nausea. Involuntary wavelike movements occurring within the alimentary canal that force contents onward is defined as peristalsis. Text Reference - p. 925
Which respiratory complication occurs due to irritation of the upper airway by gastric secretions? 1 Asthma 2 Pneumonia 3 Laryngospasm 4 Chronic bronchitis
3 Laryngospasm occurs due to irritation of the upper airway by gastric secretions. Asthma, pneumonia, and chronic bronchitis are respiratory complications that occur due to aspiration. Text Reference - p. 932
Which medication increases gastric motility and gastric emptying? 1 Sulcrafate 2 Nexium 3 Reglan 4 Pepcid
3 Prokinetic agents such as Reglan (Metoclopramide) increase gastric motility and gastric emptying.
The nurse is evaluating a patient after teaching about management of peptic ulcer disease. Which statement by the patient indicates the need for further teaching? Select all that apply. 1 "I should report increased vomiting or epigastric pain." 2 "I should avoid smoking, because it may delay healing of the ulcer." 3 "I should avoid spicy and acidic food that may cause epigastric distress." 4 "I should take medications that include only antisecretory class of drugs." 5 "I should take over-the-counter drugs that have ingredients like aspirin."
4 5 While teaching a patient about management of peptic ulcer disease, the nurse should instruct the patient to take medications that include both antisecretory drugs and antibiotics, because of the development of antibiotic resistance organisms; this can be reduced by using antisecretory drugs concurrently with antibiotics. Over-the-counter (OTC) drugs that contain ingredients like aspirin should be avoided, because they destroy mucosal cells and increase the risk of ulcer development. The patient should report increased vomiting or epigastric pain. The patient should avoid smoking, because it may delay ulcer healing. The patient should follow dietary modifications by avoiding spicy and acidic food that may cause epigastric distress. Text Reference - p. 949
A 72-year-old patient was admitted with epigastric pain caused by a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? 1 Chest pain relieved with eating or drinking water 2 Back pain three or four hours after eating a meal 3 Burning epigastric pain 90 minutes after breakfast 4 Rigid abdomen and vomiting following indigestion
4 A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with Duodenal ulcers, not gastric ulcers. Back pain three to four hours after a meal is more likely to occur with a Duodenal ulcer. Burning epigastric pain one to two hours after a meal is from an expected manifestation with a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care. Text Reference - p. 944
During rounds, the nurse notes that a patient who had a total gastrectomy the day before has a very small amount of fluid draining from the nasogastric (NG) tube. What is the nurse's priority action? 1 Increase the power on the suction device. 2 Irrigate the NG tube with 50 mL of sterile saline. 3 Notify the primary health care provider immediately. 4 Continue to monitor the patient and NG tube drainage
4 After total gastrectomy, the NG tube does not drain a large quantity of secretions because removal of the stomach has eliminated the reservoir capacity. The nurse will only need to continue to monitor the patient and the NG tube drainage. Increasing the level of suction places the patient at higher risk for acid-base imbalance. Irrigating the NG tube is not necessary. The health care provider does not need to be notified, because this is a normal finding. Text Reference - p. 951
In assessing the vital signs of a patient with an upper gastrointestinal (GI) bleed, it is important to determine whether the patient is in which kind of shock? 1 Neurogenic 2 Cardiogenic 3 Septic 4 Hypovolemic
4 Although fluctuations in vital signs occur in neurogenic, cardiogenic, and septic shock states, these fluctuations are not associated with blood loss. However, signs and symptoms of hypovolemic shock caused by GI blood loss, such as elevated heart rate, respiratory rate, and decreased blood pressure, would be evident. Assessment of the patient's vital signs assist the nurse in determining whether patient is in hypovolemic shock. Text Reference - p. 956
A patient underwent abdominal surgery four days ago and has sutures in the upper epigastric region. Which is the most appropriate initial nursing intervention to prevent pulmonary complications? 1 Administer steam inhalation. 2 Administer bronchodilator drugs. 3 Encourage early ambulation. 4 Instruct the patient to splint the incision site with a pillow while coughing.
4 Splinting the incision site with a pillow reduces the pain during coughing and deep breathing and should be taught first. Steam inhalation and bronchodilator drugs also prevent pulmonary complications but are more useful if the patient is not able to remove pulmonary secretions by himself. Early ambulation is also a measure to prevent pulmonary complications but is not applicable in the early phase of care
A nurse assesses a patient with suspected peptic ulcer disease. Which symptom will the patient most likely report? 1 Vomiting after meals 2 Abdominal distention after eating 3 Intolerance of fatty and spicy foods 4 Epigastric discomfort relieved by eating
4 Symptoms of peptic ulcer disease (PUD) are variable and often absent. However, discomfort, if present, may occur before meals or two to three hours after meals and at bedtime. The discomfort may be relieved by eating because the food will dilute and buffer gastric acid. Although vomiting or abdominal distention after meals may occur, they are less likely to be associated with PUD than is the relief caused by eating. Text Reference - p. 942
A patient presents with severe abdominal burns. Diagnostic tests reveal a discrete, deep ulcer in the fundus of the stomach. The nurse expects that the patient will be diagnosed with what? 1 Gastric ulcer 2 Duodenal ulcer 3 Stomach cancer 4 Stress-related mucosal disease (SRMD)
4 Stress Ulcers result from: --- Severe Stress, --- Sepsis, --- Burns (Curling's Ulcers), or --- Head Injuries (Cushing's ulcers) (Diffuse superficial mucosal injury or discrete deeper ulcers in the fundus and body portions of the stomach indicate stress-related mucosal disease (SRMD), which may occur as a complication of major trauma or burns. Gastric ulcers are characterized by burning or gaseous pain in the epigastric region. Duodenal ulcers are characterized by burning or cramplike pain in mid-epigastric region. Stomach cancer is characterized by early satiety, abdominal pain, and weight loss.)
What are the characteristics of gastric ulcers? Select all that apply. 1 - Gastric ulcer lesions are superficial. -2 - Gastric ulcers increase the gastric secretion. 3 - Gastric ulcers predominantly occur in antrum (the part of the stomach just inside the pylorus) 4 - Gastric ulcers cause pain one to two hours after meals. -5 - Gastric ulcers manifest as burning, cramping pain in the midepigastrium. 6 - Gastric ulcers are aggravated by food 7 - Gastric Ulcers are more common in Women; 50-60 8 - Gastric Ulcers commonly cause Nausea, Vomiting and Weight Loss
1 3 4 6 7 8 Gastric ulcer lesions are superficial, round, oval, or cone shaped. They predominantly occur in antrum and cause pain one to two hours after meals. Gastric ulcers decrease gastric secretion, whereas duodenal ulcers increase gastric secretion. In gastric ulcers, there is a burning, cramping pain in the high left epigastrium. Text Reference - p. 943
A client is diagnosed with Iodine allergy. In addition to avoiding foods with Iodine the client should be taught to report which of the following s/s? 1. Diarrhea, weight loss, and blurred vision 2. Constipation, weight gain, and cold intolerance 3. Fatigue, dry skin, and hypertension 4. Anorexia, dyspnea, and weight loss
2. Iodine is needed for TH synthesis in the thyroid gland. Without it, TH would decrease, causing a decrease in body functions, such as body heat and cell metabolism (wt gain).
The nurse is caring for a patient who presents with burning pain in the midepigastric region five hours after eating. The patient's medical history reveals pancreatic disease. Which condition does the nurse suspect? 1 Gastric ulcer 2 Acute gastritis 3 Duodenal ulcer 4 Stomach cancer
3 Duodenal ulcers are characterized by burning pain in the midepigastric region that occurs two to five hours after eating. Gastric ulcers are characterized by burning or gaseous pressure in the high left epigastrium and upper abdomen. Symptoms of acute gastritis include anorexia, nausea, vomiting, and feeling of fullness. Signs of stomach cancer include anemia, indigestion, weight loss, abdominal pain, and satiety. Text Reference - p. 944
The nurse is planning to teach the patient with gastroesophageal reflux disease (GERD) about foods or beverages that decrease lower esophageal sphincter (LES) pressure. What should be included in this list (select all that apply)? a. Alcohol b. Root beer c. Chocolate d. Citrus fruits e. Fatty foods f. Cola sodas
a. Alcohol c. Chocolate e. Fatty foods f. Cola sodas
A patient with a history of peptic ulcer disease is hospitalized with symptoms of a perforation. During the initial assessment, what should the nurse expect the patient to report? a. Vomiting of bright-red blood b. Projectile vomiting of undigested food c. Sudden, severe upper abdominal pain and back pain d. Hyperactive stomach sounds and upper abdominal swelling
c. Sudden, severe upper abdominal pain and back pain
After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops a. muscle weakness and weight loss. b. hyperthermia and severe tachycardia. c. hypertension and difficulty swallowing. d. laryngospasms and tingling in the hands and feet
d
Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy? a. Notify the doctor about bloody nasogastric (NG) drainage. b. Elevate the head of the bed to at least 30 degrees. c. Reposition the NG tube if drainage stops. d. Start oral fluids when the patient has active bowel sounds
ANS: B Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.
A 44-year-old man admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take? a. Irrigate the NG tube. b. Check the vital signs. c. Give the ordered antacid. d. Elevate the foot of the bed
ANS: B The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe
A 58-year-old patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse? a. The patient has been vomiting for 4 days. b. The patient takes antacids 8 to 10 times a day. c. The patient is lethargic and difficult to arouse. d. The patient has undergone a small intestinal resection
ANS: C A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information is also important to collect, but it does not require as quick action as the risk for aspiration
A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient's a. apical pulse. b. bowel sounds. c. breath sounds. d. abdominal girth.
ANS: C Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine.
A 62-year-old man patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about a. substitution of acetaminophen (Tylenol) for the NSAID. b. use of enteric-coated NSAIDs to reduce gastric irritation. c. reasons for using corticosteroids to treat the rheumatoid arthritis. d. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.
ANS: D Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development, and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating the patient's rheumatoid arthritis
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take a. sucralfate at bedtime and antacids before each meal. b. sucralfate and antacids together 30 minutes before meals. c. antacids 30 minutes before each dose of sucralfate is taken. d. antacids after meals and sucralfate 30 minutes before meals.
ANS: D Sucralfate (carafate) is a Cytoprotective, Anti-ulcer Drug that is taken on an EMPTY stomach - it creates a protective layer/barrier Sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications
After change-of-shift report, which patient should the nurse assess first? a. 42-year-old who has acute gastritis and ongoing epigastric pain b. 70-year-old with a hiatal hernia who experiences frequent heartburn c. 53-year-old who has dumping syndrome after a recent partial gastrectomy d. 60-year-old with nausea and vomiting who has dry oral mucosa and lethargy
ANS: D This older patient is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening
30. A patient with a peptic ulcer who has an NG tube develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which action should the nurse take next? a. Irrigate the NG tube. b. Obtain the vital signs. c. Give the ordered antacid. d. Listen for bowel sounds
Answer: B Rationale: The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. The nurse should assess the bowel sounds, but this is not the first action that the nurse should take.
Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en- gastric bypass? a. Educating the patient about the nasogastric (NG) tube b. Instructing the patient on coughing and breathing techniques c. Discussing necessary postoperative modifications in lifestyle d. Demonstrating passive range-of-motion exercises for the legs
B *Obese Patients have increased respiratory complications* - Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle will also be discussed, but avoidance of respiratory complications is the priority goal after surgery
The nurse is caring for a patient on the first postoperative day after a Roux-en-gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon? a. Bilateral crackles audible at both lung bases b. Redness, irritation, and skin breakdown in skinfolds c. *Emesis* of bile-colored fluid *past* the nasogastric (NG) tube d. Use of patient-controlled analgesia (PCA) several times an hour for pain
C Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the surgeon to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the surgeon. Frequent PCA use after bariatric surgery is expected.
What information should be included in the dietary teaching for the patient following a Roux-en-Y gastric bypass? a. Avoid sugary foods and limit fluids to prevent dumping syndrome. b. Gradually increase the amount of food ingested to preoperative levels. c. Maintain a long-term liquid diet to prevent damage to the surgical site. d. Consume foods high in complex carbohydrates, protein, and fiber to add bulk to contents
Correct answer: a Rationale: Fluids and foods high in carbohydrates tend to promote diarrhea and symptoms of dumping syndrome in patients with gastric bypass surgery. The diet generally should be high in protein and low in carbohydrates, fat, and roughage and consists of six small feedings a day because of the small stomach size. Liquid diets are likely to be used longer for the patient with a gastroplasty
The nurse cares for a 34-year-old woman after bariatric surgery. The nurse determines that discharge teaching related to diet is successful if the patient makes which statement? a. "A high protein diet that is low in carbohydrates and fat will prevent diarrhea." b. "Food should be high in fiber to prevent constipation from the pain medication." c. "Three meals a day with no snacks between meals will provide optimal nutrition." d. "Fluid intake should be at least 2000 mL per day with meals to avoid dehydration."
Correct answer: a Rationale: The diet generally prescribed is high in protein and low in carbohydrates, fat, and roughage and consists of six small feedings daily. Fluids should not be ingested with the meal, and in some cases, fluids should be restricted to less than 1000 mL per day. Fluids and foods high in carbohydrate tend to promote diarrhea and symptoms of the DUMPING syndrome. Generally, calorically dense foods (foods high in fat) should be avoided to permit more nutritionally sound food to be consumed.
Priority Decision: The nurse admitting a patient for bariatric surgery obtains the following information from the patient. Which finding should be brought to the surgeon's attention before proceeding with further patient preparation? a. History of hypertension b. History of untreated depression c. History of multiple attempts at weight loss d. History of sleep apnea treated with continuous positive airway pressure (CPAP)
Correct answer: b Rationale: Patients with histories of untreated depression or psychosis are not good candidates for surgery. All other historical information includes medical complications of severe obesity that would help to qualify the patient for the surgery
In the immediate postoperative period a nurse cares for a severely obese 72-year-old man who had surgery for repair of a lower leg fracture. Which assessment would be most important for the nurse to make? a. Cardiac rhythm b. Surgical dressing c. Postoperative pain d. Oxygen saturation
Correct answer: d Rationale: After surgery an older and/or severely obese patient should be closely monitored for oxygen desaturation. *The body stores anesthetics in adipose tissue, placing patients with excess adipose tissue (e.g., obesity, older) at risk for resedation.* As adipose cells release anesthetic back into the bloodstream, the patient may become sedated after surgery. This may depress the respiratory rate and result in a drop in oxygen saturation.
What characteristics describe adjustable gastric banding (select all that apply)? a. 85% of the stomach is removed. b. Stomach restriction can be reversed. c. Eliminates hormones that stimulate hunger. d. Malabsorption of fat-soluble vitamins occurs. e. Inflatable band allows for modification of gastric stoma size. f. Stomach with a gastric pouch surgically anastomosed to the jejunum
Correct answers: b, e Rationale: The adjustable gastric banding procedure is reversible and allows a change in gastric stoma size by inflation or deflation of the band around the funds of the stomach. The vertical sleeve gastrectomy removes 85% of the stomach and eliminates the hormones produced in the stomach that stimulate hunger. The biliopancreatic diversion is a maladaptive surgery that prevents absorption of nutrients, including fat-soluble vitamins. The Roux-en-Y gastric bypass reduces the stomach size with a gastric pouch anastomosed to the small intestine, so it is both restrictive and malabsorptive
Diagnostic testing of a patient with Grave's disease will reveal __________ TSH levels
Diagnostic testing of a patient with Grave's disease will reveal DECREASED TSH levels (when T3/T4 levels are high, pituitary decreases secretion of TSH in attempt to lower thyroid hormones)
Which factors increase intraabdominal pressure and lead to the development of a hiatal hernia? Select all that apply. 1 Ascites 2 Obesity 3 Pregnancy 4 Fatty foods 5 Peppermint
Factors increasing intraabdominal pressure include ascites, obesity, and pregnancy. They may lead to the development of a hiatal hernia. Fatty foods and peppermint are factors that decrease lower esophageal sphincter pressure. Text Reference - p. 936
A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing? - Keep the patient NPO. - Put the bed in the Trendelenberg position. - Have the patient eat 4 to 6 smaller meals each day. - Give various antacids to determine which one works for the patient.
Have the patient eat 4 to 6 smaller meals each day. Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the care provider's prescription, so this is not a nursing intervention
Which patient is at highest risk for having a gastric ulcer? a. 55-year-old female, smoker, with nausea and vomiting b. 45-year-old female admitted for illicit drug detoxification c. 37-year-old male, smoker, who fell while looking for a job d. 27-year old male who is being divorced and has back pain
a. 55-year-old female, smoker, with nausea and vomiting The 55-year-old female smoker experiencing nausea and vomiting is more likely to have a gastric ulcer. The other patients are not in the highest-risk age range or do not have enough risk factors. Although lower socioeconomic status, smoking, and drug use do increase the risk of gastric ulcers, these patients are more likely to experience duodenal ulcers but further assessment is needed
Regardless of the precipitating factor, what causes the injury to mucosal cells in peptic ulcers? a. Acid back diffusion into the mucosa b. The release of histamine from GI cells c. Ammonia formation in the mucosal wall d. Breakdown of the gastric mucosal barrier
a. Acid back diffusion into the mucosa The ultimate damage to the tissues of the stomach and duodenum, precipitating ulceration, is acid back diffusion into the mucosa. The gastric mucosal barrier is protective of the mucosa but without the acid environment and damage, ulceration does not occur. Ammonia formation by H. pylori and release of histamine impair the barrier but are not directly responsible for tissue injury
Priority Decision: A patient with a gastric outlet obstruction has been treated with NG decompression. After the first 24 hours, the patient develops nausea and increased upper abdominal bowel sounds. What is the best action by the nurse? a. Check the patency of the NG tube. b. Place the patient in a recumbent position. c. Assess the patient's vital signs and circulatory status. d. Encourage the patient to deep breathe and consciously relax.
a. Check the patency of the NG tube. If symptoms of gastric outlet obstruction, such as nausea,vomiting, and stomach distention, occur while the patient is on NPO status or has an NG tube, the patency of the NG tube should be assessed. A recumbent position should not be used in a patient with a gastric outlet obstruction because it increases abdominal pressure on the stomach and vital signs and circulatory status assessment are important if hemorrhage or perforation is suspected. Deep breathing and relaxation may help some patients with nausea but not when stomach contents are obstructed from flowing into the small intestine
A patient has a low serum T3 level. The health care provider orders measurement of the TSH level. If the TSH level is elevated, what does this indicate? a. The cause of the low T3 level is most likely primary hypothyroidism. b. The negative feedback system is failing to stimulate the anterior pituitary gland. c. The patient has an underactive thyroid gland that is not receiving TSH stimulation. d. Most likely there is a tumor on the anterior pituitary gland that is causing increased production of TSH.
a. Endocrine disorders related to hormone secretion from glands that are stimulated by tropic hormones can be caused by a malsecretion of the tropic hormone or of the target gland. If the problem is in the target gland, it is known as a primary endocrine disorder; a problem with tropic hormone secretion is known as a secondary endocrine disorder. Serum levels of tropic hormones can illustrate the status of the negative feedback system in relation to target organ hormone levels. Normally, if a target organ produces low amounts of hormone, tropic hormones will be increased; if a target organ is overproducing hormones, tropic hormones will be low or undetectable.
Which medications are used to decrease gastric or hydrochloric acid secretion (select all that apply)? a. Famotidine (Pepcid) b. Sulcrafate (Carafate) c. Omeprazole (Prilosec) d. Bethanechol (Urecholine) e. Metoclopramide (Reglan) f. Calcium Carbonate (Tums)
a. Famotidine (Pepcid - H2 Histamine Blocker) c. Omeprazole (Prilosec - PPI) Sulcrafate (Carafate) - Cytoprotective: - Anti-Ulcer drugs - forms a protective layer/barrier against acids, bile salts, and stomach enzymes - Take on Empty Stomach Bethanechol (Urecholine) - Cholinergic: Increases Lower Esophageal Pressure thus improving esophageal emptying into stomach Metoclopramide (Reglan) - Prokinetic Improves gastric motility (promotes gastric emptying) thus reducing gastric reflux into esophagus Calcium Carbonate (Tums) - Antacids - Neutralizes HCl acid - Provides Short-term relief - Take 1-3 hours After meals and at Bedtime
What type of bleeding will a patient with peptic ulcer disease with a SLOW upper GI source of bleeding have? a. Melena b. Occult blood c. Coffee-ground emesis d. Profuse bright-red hematemesis
a. Melena is black, tarry stools from SLOW bleeding from an upper GI source when blood passes through the GI tract and is digested. Occult blood is the presence of guaiac-positive stools or gastric aspirate. Coffee-ground emesis is blood that has been in the stomach for some time and has reacted with gastric secretions. Profuse bright-red hematemesis is arterial blood that has not been in contact with gastric secretions, as in esophageal or oral bleeding.
Duodenal and gastric ulcers have similar as well as differentiating features. What are characteristics unique to duodenal ulcers (select all that apply)? a. Pain is relieved with eating food. b. They have a high recurrence rate. c. Increased gastric secretion occurs. d. Associated with Helicobacter pylori infection. e. Hemorrhage, perforation, and obstruction may result. f. There is burning and cramping in the midepigastric area
a. Pain is relieved with eating food. c. Increased gastric secretion occurs. f. There is burning and cramping in the midepigastric area. Duodenal ulcers have increased gastric secretion, which causes the burning and cramping in the midepigastric area, and the pain is relieved with food. The other options occur with both duodenal and gastric ulcers
A patient has a total serum calcium level of 3 mg/dL (1.5 mEq/L). If this finding reflects hypoparathyroidism, the nurse would expect further diagnostic testing to reveal a. decreased serum PTH. b. increased serum ACTH. c. increased serum glucose. d. decreased serum cortisol levels
a. decreased serum PTH.
Which abnormal assessment findings are related to thyroid dysfunction (select all that apply)? a. Tetanic muscle spasms with hypofunction of thyroid b. Heat intolerance caused by hyperfunction of thyroid c. Exophthalmos associated with excessive secretion of Thyroid hormones d. Hyperpigmentation associated with hypofunction of thyroid e. A goiter with either hyperfunction or hypofunction of thyroid f. Increase in hand and foot size associated with excessive secretion
b, c, e. Heat intolerance, exophthalmos, and a goiter are all related to thyroid dysfunction. Tetanic muscle spasms are related to hypofunction of the parathyroid. (pth increases calcium in blood - hypofunction of parathyroid causes lack of parathyroid hormone pth which leads to low blood calcium levels and causes tetanic muscle spasms) Hyperpigmentation is related to hypofunction of the adrenal gland. Increased hand and foot size is related to excess growth hormone secretion.
After bariatric surgery, a patient who is being discharged tells the nurse, "I prefer to be independent. I am not interested in any support groups." Which response by the nurse is best? a. "I hope you change your mind so that I can suggest a group for you." b. "Tell me what types of resources you think you might use after this surgery." c. "Support groups have been found to lead to more successful weight loss after surgery." d. "Because there are many lifestyle changes after surgery, we recommend support
b. "Tell me what types of resources you think you might use after this surgery." This statement allows the nurse to assess the individual patient's potential needs and preferences. The other statements offer the patient more information about the benefits of support groups but fail to acknowledge the patient's preferences
The nurse is caring for a patient after bariatric surgery. What should be included in the plan of care (select all that apply.)? a. Teach the patient to increase carbohydrate intake. b. Assess for incisional pain versus anastomosis leak. c. Maintain elevation of the head of bed at 35-45 degrees. d.Monitor for vomiting that is a common complication. e. Instruct the patient to consume liquids frequently during meals. f. Assist with early independent ambulation during hospitalization
b. Assess for incisional pain versus anastomosis leak. c. Maintain elevation of the head of bed at 35-45 degrees d.Monitor for vomiting that is a common complication. f. Assist with early independent ambulation during hospitalization After bariatric surgery, the nurse needs to assess for incisional pain versus anastomosis leak. Because vomiting is a common postoperative complication, maintain elevation of the head of bed to reduce the risk of vomiting and aspiration. Dietary recommendations include six small meals that are high in protein and low in carbohydrates and fat. Fluids should be avoided during meals to prevent dumping syndrome. Early ambulation with assistance is recommended
What type of pain does the nurse expect a patient with an ulcer of the posterior portion of the duodenum to experience? a. Pain that occurs after not eating all day b. Back pain that occurs 2 to 4 hours following meals c. Midepigastric pain that is unrelieved with antacids d. High epigastric burning that is relieved with food intake
b. Back pain that occurs 2 to 4 hours following meals Back pain is a common manifestation of ulcers located on the posterior aspect of the duodenum and is important for nurses to keep in mind during assessment of the patient, because the more typical epigastric burning and pain may not be present. Duodenal ulcers are more often relieved by food than are gastric ulcers and when epigastric discomfort occurs, it is lower than that of gastric ulcers. Eating stimulates gastric acid production, increasing discomfort for patients with gastric ulcers, whereas the pain of duodenal ulcers usually occurs several hours after eating
What should the nurse emphasize when teaching patients at risk for upper GI bleeding to prevent bleeding episodes? a. All stools and vomitus must be tested for the presence of blood. b. The use of over-the-counter (OTC) medications of any kind should be avoided. c. Antacids should be taken with all prescribed medications to prevent gastric irritation. d. Misoprostol (Cytotec) should be used to protect the gastric mucosa in individuals with peptic ulcers
b. The use of over-the-counter (OTC) medications of any kind should be avoided. All over-the-counter (OTC) drugs should be avoided because their contents may include drugs that are contraindicated because of the irritating effects on the gastric mucosa. Patients are taught to test suspicious vomitus or stools for occult blood but all stools do not need to be tested. Antacids cannot be taken with all medications because they prevent the absorption of many drugs. Misoprostol is used to protect the gastric mucosa in patients who must take NSAIDs for other conditions because it inhibits acid secretion stimulated by NSAIDs
What medication is used with thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones? a. Potassium iodide b. Atenolol (Tenormin) c. Propylthiouracil (PTU) d. Radioactive iodine (RAI)
b. The β-adrenergic blocker atenolol is used to block the sympathetic nervous system stimulation by thyroid hormones. Potassium iodide is used to prepare the patient for thyroidectomy or for treatment of thyrotoxic crisis to inhibit the synthesis of thyroid hormones. Antithyroid medications inhibit the synthesis of thyroid hormones. Radioactive iodine (RAI) therapy destroys thyroid tissue, which limits thyroid hormone secretion.
Nursing management of the patient with chronic gastritis includes teaching the patient to a. take antacids before meals to decrease stomach acidity. b. maintain a nonirritating diet with six small meals a day. c. eliminate alcohol and caffeine from the diet when symptoms occur. d. use nonsteroidal antiinflammatory drugs (NSAIDs) instead of aspirin for minor pain relief.
b. maintain a non-irritating diet with six small meals a day A nonirritating diet with six small meals a day is recommended to help control the symptoms of gastritis. Nonsteroidal antiinflammatory drugs (NSAIDs) are often as irritating to the stomach as aspirin and should not be used in the patient with gastritis. Antacids are often used for control of symptoms but have the best neutralizing effect if taken after meals. Alcohol and caffeine should be eliminated entirely because they may precipitate gastritis.
The nurse determines that teaching for the patient with peptic ulcer disease has been effective when the patient makes which statement? a. "I should stop all my medications if I develop any side effects." b. "I should continue my treatment regimen as long as I have pain." c. "I have learned some relaxation strategies that decrease my stress." d. "I can buy whatever antacids are on sale because they all have the same effect."
c. "I have learned some relaxation strategies that decrease my stress."
What does the nurse include when teaching a patient with newly diagnosed peptic ulcer disease? a. Maintain a bland, soft, low-residue diet. b. Use alcohol and caffeine in moderation and always with food. c. Eat as normally as possible, eliminating foods that cause pain or discomfort. d. Avoid milk and milk products because they stimulate gastric acid production.
c. Eat as normally as possible, eliminating foods that cause pain or discomfort. There is no specific diet used for the treatment of peptic ulcers and patients are encouraged to eat as normally as possible, eliminating foods that cause discomfort or pain. Eating six meals a day prevents the stomach from being totally empty and is also recommended. Caffeine and alcohol should be eliminated from the diet because they are known to cause gastric irritation. Milk and milk products do not need to be avoided but they can add fat content to the diet
A patient is admitted to the hospital with thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and laryngeal stridor b. Bulging eyeballs and dysrhythmias c. Elevated temperature and signs of heart failure d. Lethargy progressing suddenly to impairment of consciousness
c. Elevated temperature and signs of heart failure A hyperthyroid crisis results in marked manifestations of hyperthyroidism, with severe Tachycardia, Heart Failure, Sock, Hyperthermia, Restlessness, irritability, abdominal pain, vomiting, diarrhea, delirium, and coma. Although exophthalmos may be present in the patient with Graves' disease, it is not a significant factor in hyperthyroid crisis. Hoarseness and laryngeal stridor are characteristic of the tetany of hypoparathyroidism and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.
Corticosteroid medications are associated with the development of peptic ulcers because of which probable pathophysiologic mechanism? a. The enzyme urease is produced. b. Secretion of hydrochloric acid is increased. c. The rate of mucous cell renewal is decreased. d. The synthesis of mucus and prostaglandins is inhibited.
c. The rate of mucous cell renewal is decreased. Corticosteroids decrease the rate of mucous cell renewal. H. pylori produces the enzyme urease. Alcohol ingestion increases the secretion of hydrochloric acid. Aspirin and NSAIDs inhibit the synthesis of mucus and prostaglandins.
Priority Decision: When caring for a patient with an acute exacerbation of a peptic ulcer, the nurse finds the patient doubled up in bed with shallow, grunting respirations. Which action should the nurse take first? a. Irrigate the patient's NG tube. b. Notify the health care provider. c. Place the patient in high-Fowler's position. d. Assess the patient's abdomen and vital signs
d. Assess the patient's abdomen and vital signs abdominal pain that causes the knee to be drawn up and shallow, grunting respiration in a patient with peptic ulcer disease are characteristic of perforation and the nurse should assess the pts vital signs and abdomen before notifying the health care provider. Irrigation of the ng tube should not be performed because the additional fluid may be spilled into the peritoneal cavity and the patient should be placed in a position of comfort usually on the side with the head slightly elevated
Priority Decision: While caring for a patient following a subtotal gastrectomy with a gastroduodenostomy anastomosis, the nurse determines that the NG tube is obstructed. Which action should the nurse take first? a. Replace the tube with a new one. b. Irrigate the tube until return can be aspirated. c. Reposition the tube and then attempt irrigation. d. Notify the surgeon to reposition or replace the tube
d. Notify the surgeon to reposition or replace the tube If the patient's NG tube becomes obstructed following a gastrectomy with an intestinal anastomosis, gastric secretions may put a strain on the sutured anastomosis and cause serious complications. Be sure that the suction is working and the health care provider may order periodic gentle irrigation with normal saline solution. Because of the danger of perforating the gastric mucosa or disrupting the suture line, the nurse should notify the health care provider if the tube needs to be repositioned or replaced.
Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm? a. Iodine b. Methimazole c. Propylthiouracil d. Propranolol (Inderal)
d. Propranolol (Inderal) b-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.
What is the rationale for treating acute exacerbation of peptic ulcer disease with NG intubation? a. Stop spillage of GI contents into the peritoneal cavity b. Remove excess fluids and undigested food from the stomach c. Feed the patient the nutrients missing from the lack of ingestion d. Remove stimulation for hydrochloric acid and pepsin secretion by keeping the stomach empty
d. Remove stimulation for hydrochloric acid and pepsin secretion by keeping the stomach empty NG intubation is used with acute exacerbation of peptic ulcer disease to remove the stimulation for hydrochloric acid (HCl) and pepsin secretion by keeping the stomach empty. Stopping the spillage of GI contents into the peritoneal cavity is used for peritonitis. Removing excess fluids and undigested food from the stomach is the rationale for using NG intubation for gastric outlet obstruction.
Following a Billroth II procedure, a patient develops dumping syndrome. The nurse should explain that the symptoms associated with this problem are caused by a. distention of the smaller stomach by too much food and fluid intake. b. hyperglycemia caused by uncontrolled gastric emptying into the small intestine. c. irritation of the stomach lining by reflux of bile salts because the pylorus has been removed. d. movement of fluid into the small bowel because concentrated food and fluids move rapidly into the intestine
d. movement of fluid into the small bowel because concentrated food and fluids move rapidly into the intestine Because there is no sphincter control of food taken into the stomach following a Billroth II procedure, concentrated food and fluid move rapidly into the small intestine, creating a hypertonic environment that pulls fluid from the bowel wall into the lumen of the intestine, reducing plasma volume and distending the bowel. Postprandial hypoglycemia occurs when the concentrated carbohydrate bolus in the small intestine results in hyperglycemia and the release of excessive amounts of insulin into the circulation, resulting in symptoms of hypoglycemia. Irritation of the stomach by bile salts causes epigastric distress after meals, not dumping syndrome.
