Chapter 55 - Stomach Disorders
A patient has been discharged home after surgery for gastric cancer, and a case manager will follow up with the patient. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? a. Schedule of the patient's follow-up examinations and diagnostic testing b. Information on family members' progress in learning how to perform dressing changes c. Copy of the diet plan prepared for the patient by the hospital dietitian d. Detailed account of what occurred during the patient's surgical procedure
A
A patient is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? a. Starting a large-bore IV b. Administering IV pain medication c. Preparing equipment for intubation d. Monitoring the patient's anxiety level
A
A patient is scheduled to be discharged home after a gastrectomy and will need to perform daily dressing changes on the surgical wound. What is the nurse's highest priority intervention? a. Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider b. Asking the primary health care provider for a referral for home health services to assist with dressing changes c. Asking the spouse if any other family members are in the medical profession and could help change the dressing d. Offer literature on dressing changes and schedule follow-up phone calls with the patient and spouse to talk them through dressing changes when at home.
A
An older female patient is diagnosed with gastric cancer. Which statement made by the patient's family demonstrates a correct understanding of the disorder? a. "This may be related to her recurring ulcer disease." b. "This cancer is probably curable with surgery." c. "Gastric cancer has a strong genetic component." d. "Thank goodness she won't have to undergo surgery."
A
The nurse has placed a nasogastric (NG) tube in a patient with upper gastrointestinal (GI) bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? a. "A fluid solution goes down the tube to help clean out your stomach." b. "The medication goes down the tube to help clean out your stomach." c. "The primary health care provider requested the tube to be placed just in case it was needed." d. "We'll start feeding you through it once your stomach is cleaned out."
A
The nurse is caring for an older adult male patient who reports stomach pain and heartburn. Which sign/symptom is most significant suggesting the patient's ulceration is duodenal in origin and not gastric? a. Pain occurs 1½ to 3 hours after a meal, usually at night. b. Pain is worsened by the ingestion of food. c. The patient has a malnourished appearance. d. The patient is a man older than 50 years.
A
The nurse is teaching a patient with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the patient indicates a need for further teaching before discharge? a. "Nizatidine (Axid) needs to be taken three times a day to be effective." b. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." c. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." d. "Omeprazole (Prilosec) should be swallowed whole and not crushed."
A
The nurse working during the day shift on the medical unit has just received report. Which patient does the nurse plan to assess first? a. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy b. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal c. Middle-aged patient with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast d. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy
A
A patient has a long-term history of Crohn's disease and has recently developed acute gastritis. The patient asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? a. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." b. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." c. "What has your doctor told you about how your gastritis developed?" d. "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"
B
A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? a. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." b. "These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen." c. "Yes, these are known to be effective in managing this disease but make sure you research the herbs thoroughly before taking them." d. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."
B
The admission assessment for a patient with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? a. Type and crossmatch for 4 units of packed red blood cells. b. Infuse 0.9% normal saline solution at 200 mL/hr. c. Give pantoprazole (Protonix) 40 mg IV now and then daily. d. Insert a nasogastric tube and connect to low intermittent suction.
B
The nurse is reviewing admitting requests for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? a. Apply antiembolism stockings. b. Place a nasogastric (NG) tube, and connect to suction. c. Insert an indwelling catheter, and check output hourly. d. Give famotidine (Pepcid) 20 mg IV every 12 hours.
B
The nurse is teaching a patient about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the patient indicates a need for further teaching? a. "I will need to avoid sweetened fruit juice beverages." b. "I can eat ice cream in moderation." c. "I cannot drink alcohol at all." d. "It is okay to have a serving of sugar-free pudding."
B
Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? a. Retape the nasogastric tube for a patient who has had a subtotal gastrectomy and vagotomy. b. Reinforce the teaching previously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis. c. Document instructions for a patient with chronic gastritis about how to use "triple therapy." d. Assess the gag reflex for a patient who has arrived from the post anesthesia care unit after a laparoscopic gastrectomy.
B
The nurse and the dietitian are planning sample diet menus for a patient who is experiencing dumping syndrome. Which sample meal is best for this patient? a. Chicken salad on whole wheat bread b. Liver and onions c. Chicken and rice d. Cobb salad with buttermilk ranch dressing
C
The nurse finds a patient vomiting coffee-ground emesis. On assessment, the patient has a blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? a. Administering a histamine2 (H2) antagonist b. Initiating enteral nutrition c. Administering intravenous (IV) fluids d. Administering antianxiety medication
C
The nurse is teaching a patient how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the patient demonstrates a correct understanding of the nurse's instruction? a. "It is okay to continue to drink coffee in the morning when I get to work." b. "I will need to take vitamin B12 shots for the rest of my life." c. "I should avoid alcohol and tobacco." d. "I should eat small meals about six times a day."
C
A patient with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds (2.3 kg) of body weight has been regained. The patient is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this patient? a. Explain to the patient the importance of drinking the enteral supplements prescribed. b. Ask the patient's family to try to persuade the patient to drink the supplements. c. Inform the patient that a nasogastric tube may be necessary if he or she fails to comply. d. Ask the patient if a change in flavor would make the supplement more palatable.
D
The nurse is monitoring a patient with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding? a. Respiratory rate from 24 to 20 breaths/min b. Apical pulse from 80 to 72 beats/min c. Temperature from 97.9° F to 98.9° F (36.6°C to 37.2°C) d. Blood pressure from 140/90 to 110/70 mm Hg
D
The nurse reviews a medication history for a patient newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the primary health care provider will request which medication for this patient? a. Bismuth subsalicylate (Pepto-Bismol) b. Magnesium hydroxide (Maalox) c. Metronidazole (Flagyl) d. Misoprostol (Cytotec)
D
Which patient assessment information is correlated with a diagnosis of chronic gastritis? a. Anorexia, nausea, and vomiting b. Frequent use of corticosteroids c. Hematemesis and anorexia d. Radiation therapy, smoking, and excessive alcohol use
D