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A nurse is caring for a patient who has a diagnosis of GI bleed. During shift assessment, the nurse finds the patient to be tachycardic and hypotensive, and the patient has an episode of hematemesis while the nurse is in the room. In addition to monitoring the patients vital signs and level of consciousness, what would be a priority nursing action for this patient?
- A. Place the patient in a prone position.
- B. Provide the patient with ice water to slow any GI bleeding.
- C. Prepare for the insertion of an NG tube.
- D. Notify the physician.
Correct Answer: D
Rationale: The nurse must always be alert for any indicators of hemorrhagic gastritis, which include hematemesis (vomiting of blood), tachycardia, and hypotension. If these occur, the physician is notified and the patients vital signs are monitored as the patients condition warrants. Putting the patient in a prone position could lead to aspiration. Giving ice water is contraindicated as it would stimulate more vomiting.
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A patient has been diagnosed with peptic ulcer disease and the nurse is reviewing his prescribed medication regimen with him. What is currently the most commonly used drug regimen for peptic ulcers?
- A. Bismuth salts, antivirals, and histamine-2 (H2) antagonists
- B. H2 antagonists, antibiotics, and bicarbonate salts
- C. Bicarbonate salts, antibiotics, and ZES
- D. Antibiotics, proton pump inhibitors, and bismuth salts
Correct Answer: D
Rationale: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. H2 receptor antagonists are used to treat NSAID-induced ulcers and other ulcers not associated with H. pylori infection, but they are not the drug of choice. Bicarbonate salts are not used. ZES is the Zollinger-Ellison syndrome and not a drug.
A patient is one month postoperative following restrictive bariatric surgery. The patient tells the clinic nurse that he has been having trouble swallowing for the past few days. What recommendation should the nurse make?
- A. Eating more slowly and chewing food more thoroughly
- B. Taking an OTC antacid or drinking a glass of milk prior to each meal
- C. Chewing gum to cause relaxation of the lower esophageal sphincter
- D. Drinking at least 12 ounces of liquid with each meal
Correct Answer: A
Rationale: Dysphagia may be prevented by educating patients to eat slowly, to chew food thoroughly, and to avoid eating tough foods such as steak or dry chicken or doughy bread. After bariatric procedures, patients should normally not drink beverages with meals. Medications or chewing gum will not alleviate this problem.
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 comes to the clinic complaining of pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the patient has a peptic ulcer?
- A. Does your pain resolve when you have something to eat?
- B. Do over-the-counter pain medications help your pain?
- C. Does your pain get worse if you get up and do some exercise?
- D. Do you find that your pain is worse when you need to have a bowel movement?
Correct Answer: A
Rationale: Pain relief after eating is associated with duodenal ulcers. The pain of peptic ulcers is generally unrelated to activity or bowel function and may or may not respond to analgesics.
A patient with gastritis required hospital treatment for an exacerbation of symptoms and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the patients continuing care in the home setting, what assessment question is most relevant?
- A. Does anyone in your family have experience at giving injections?
- B. Are you going to be anywhere with strong sunlight in the next few months?
- C. Are you aware of your blood type?
- D. Do any of your family members have training in first aid?
Correct Answer: A
Rationale: Patients with malabsorption of vitamin B12 need information about lifelong vitamin B12 injections; the nurse may instruct a family member or caregiver how to administer the injections or make arrangements for the patient to receive the injections from a health care provider. Questions addressing sun exposure, blood type, and first aid are not directly relevant.