Nokea
A nurse is admitting a patient to the postsurgical unit following a gastrostomy. When planning assessments, the nurse should be aware of what potential postoperative complication of a gastrostomy?
- A. Premature removal of the G tube
- B. Bowel perforation
- C. Constipation
- D. Development of peptic ulcer disease (PUD)
Correct Answer: A
Rationale: A significant postoperative complication of a gastrostomy is premature removal of the G tube. Constipation is a less immediate threat and bowel perforation and PUD are not noted to be likely complications.
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The nurse is preparing to insert a patients ordered NG tube. What factor should the nurse recognize as a risk for incorrect placement?
- A. The patient is obese and has a short neck.
- B. The patient is agitated.
- C. The patient has a history of gastroesophageal reflux disease (GERD).
- D. The patient is being treated for pneumonia.
Correct Answer: B
Rationale: Inappropriate placement may occur in patients with decreased levels of consciousness, confused mental states, poor or absent cough and gag reflexes, or agitation during insertion. A short neck, GERD, and pneumonia are not linked to incorrect placement.
The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. Which of the nurses assessments most directly addresses a major complication of TPN?
- A. Checking the patients capillary blood glucose levels regularly
- B. Having the patient frequently rate his or her hunger on a 10-point scale
- C. Measuring the patients heart rhythm at least every 6 hours
- D. Monitoring the patients level of consciousness each shift
Correct Answer: A
Rationale: The solution, used as a base for most TPN, consists of a high dextrose concentration and may raise blood glucose levels significantly, resulting in hyperglycemia. This is a more salient threat than hunger, though this should be addressed. Dysrhythmias and decreased LOC are not among the most common complications.
A nurse is caring for a patient who has a gastrointestinal tube in place. Which of the following are indications for gastrointestinal intubation? Select all that apply.
- A. To remove gas from the stomach
- B. To administer clotting factors to treat a GI bleed
- C. To remove toxins from the stomach
- D. To open sphincters that are closed
- E. To diagnose GI motility disorders
Correct Answer: A,C,E
Rationale: GI intubation may be performed to decompress the stomach and remove gas and fluid, lavage (flush with water or other fluids) the stomach and remove ingested toxins or other harmful materials, diagnose disorders of GI motility and other disorders, administer medications and feedings, compress a bleeding site, and aspirate gastric contents for analysis. GI intubation is not used for opening sphincters that are not functional or for administering clotting factors.
A patients enteral feedings have been determined to be too concentrated based on the patients development of dumping syndrome. What physiologic phenomenon caused this patients complication of enteral feeding?
- A. Increased gastric secretion of HCl and gastrin because of high osmolality of feeds
- B. Entry of large amounts of water into the small intestine because of osmotic pressure
- C. Mucosal irritation of the stomach and small intestine by the high concentration of the feed
- D. Acid-base imbalance resulting from the high volume of solutes in the feed
Correct Answer: B
Rationale: When a concentrated solution of high osmolality entering the intestines is taken in quickly or in large amounts, water moves rapidly into the intestinal lumen from fluid surrounding the organs and the vascular compartment. This results in dumping syndrome. Dumping syndrome is not the result of changes in HCl or gastrin levels. It is not caused by an acid-base imbalance or direct irritation of the GI mucosa.
A patient has been brought to the emergency department by EMS after telling a family member that he deliberately took an overdose of NSAIDs a few minutes earlier. If lavage is ordered, the nurse should prepare to assist with the insertion of what type of tube?
- A. Nasogastric tube
- B. Levin tube
- C. Gastric sump
- D. Orogastric tube
Correct Answer: D
Rationale: An orogastric tube is a large-bore tube inserted through the mouth with a wide outlet for removal of gastric contents; it is used primarily in the emergency department or an intensive care setting. Nasogastric, Levin, and gastric sump tubes are not used for this specific purpose.