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A nurse is presenting a class at a bariatric clinic about the different types of surgical procedures offered by the clinic. When describing the implications of different types of surgeries, the nurse should address which of the following topics? Select all that apply.
- A. Specific lifestyle changes associated with each procedure
- B. Implications of each procedure for eating habits
- C. Effects of different surgeries on bowel function
- D. Effects of various bariatric surgeries on fertility
- E. Effects of different surgeries on safety of future immunizations
Correct Answer: A,B,C
Rationale: Different bariatric surgical procedures entail different lifestyle modifications; patients must be well informed about the specific lifestyle changes, eating habits, and bowel habits that may result from a particular procedure. Bariatric surgeries do not influence the future use of immunizations or fertility, though pregnancy should be avoided for 18 months after bariatric surgery.
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A nurse caring for a patient who has had bariatric surgery is developing a teaching plan in anticipation of the patients discharge. Which of the following is essential to include?
- A. Drink a minimum of 12 ounces of fluid with each meal.
- B. Eat several small meals daily spaced at equal intervals.
- C. Choose foods that are high in simple carbohydrates.
- D. Sit upright when eating and for 30 minutes afterward.
Correct Answer: B
Rationale: Due to decreased stomach capacity, the patient must consume small meals at intervals to meet nutritional requirements while avoiding a feeling of fullness and complications such as dumping syndrome. The patient should not consume fluids with meals and low-Fowlers positioning is recommended during and after meals. Carbohydrates should be limited.
A patient has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. What would be the nursing care most needed by the patient at this time?
- A. Teaching the patient about necessary nutritional modification
- B. Helping the patient weigh treatment options
- C. Teaching the patient about the etiology of gastritis
- D. Providing the patient with physical and emotional support
Correct Answer: D
Rationale: For acute gastritis, the nurse provides physical and emotional support and helps the patient manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The scenario describes a newly diagnosed patient; teaching about the etiology of the disease, lifestyle modifications, or various treatment options would be best provided at a later time.
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 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.
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.