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A nurse in the postanesthesia care unit admits a patient following resection of a gastric tumor. Following immediate recovery, the patient should be placed in which position to facilitate patient comfort and gastric emptying?
- A. Fowlers
- B. Supine
- C. Left lateral
- D. Left Sims
Correct Answer: A
Rationale: Positioning the patient in a Fowlers 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. Supine positioning and the left lateral (left Sims) position do not achieve this goal.
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A patient has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurses priority intervention?
- A. Administration of antiemetics
- B. Insertion of an NG tube for decompression
- C. Infusion of hypotonic IV solution
- D. Administration of proton pump inhibitors as ordered
Correct Answer: B
Rationale: In treating the patient with gastric outlet obstruction, the first consideration is to insert an NG tube to decompress the stomach. This is a priority over fluid or medication administration.
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. Adequate understanding of required lifestyle changes
- C. Positive body image and high self-esteem
- D. Insight into why past weight loss efforts failed
Correct Answer: B
Rationale: Patients seeking bariatric surgery should be free of serious mental disorders and motivated to comply with lifestyle changes related to eating patterns, dietary choices, and elimination. 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 clients 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.
A patient has experienced symptoms of dumping syndrome following bariatric surgery. To what physiologic phenomenon does the nurse attribute this syndrome?
- 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. A sudden release of peptides
Correct Answer: D
Rationale: For many years, it had been theorized that the hypertonic gastric food boluses that quickly transit into the intestines drew extracellular fluid from the circulating blood volume into the small intestines to dilute the high concentration of electrolytes and sugars, resulting in symptoms. Now, it is thought that this rapid transit of the food bolus from the stomach into the small intestines instead causes a rapid and exuberant release of metabolic peptides that are responsible for the symptoms of dumping syndrome. It is not a result of phrenic nerve irritation, malabsorption, or bile reflux.
A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole (Prilosec). How should the nurse best describe this medications therapeutic action?
- A. This medication will reduce the amount of acid secreted in your stomach.
- B. This medication will make the lining of your stomach more resistant to damage.
- C. This medication will specifically address the pain that accompanies peptic ulcer disease.
- D. This medication will help your stomach lining to repair itself.
Correct Answer: A
Rationale: Proton pump inhibitors like Prilosec inhibit the synthesis of stomach acid. PPIs do not increase the durability of the stomach lining, relieve pain, or stimulate tissue repair.
A patient has been prescribed orlistat (Xenical) for the treatment of obesity. When providing relevant health education for this patient, the nurse should ensure the patient is aware of what potential adverse effect of treatment?
- A. Bowel incontinence
- B. Flatus with oily discharge
- C. Abdominal pain
- D. Heat intolerance
Correct Answer: B
Rationale: Side effects of orlistat include increased frequency of bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, and decreased absorption of some vitamins. This drug does not cause bowel incontinence, abdominal pain, or heat intolerance.