Nokea
A nurse is providing care for a patient who is postoperative day 2 following gastric surgery. The nurses assessment should be planned in light of the possibility of what potential complications? Select all that apply.
- A. Malignant hyperthermia
- B. Atelectasis
- C. Pneumonia
- D. Metabolic imbalances
- E. Chronic gastritis
Correct Answer: B,C,D
Rationale: After surgery, the nurse assesses the patient for complications secondary to the surgical intervention, such as pneumonia, atelectasis, or metabolic imbalances resulting from the GI disruption. Malignant hyperthermia is an intraoperative complication. Chronic gastritis is not a surgical complication.
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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 nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The patient has recently been prescribed misoprostol (Cytotec). What would the nurse be most accurate in informing the patient about the drug?
- A. It reduces the stomachs volume of hydrochloric acid
- B. It increases the speed of gastric emptying
- C. It protects the stomachs lining
- D. It increases lower esophageal sphincter pressure
Correct Answer: C
Rationale: Misoprostol is a synthetic prostaglandin that, like prostaglandin, protects the gastric mucosa. NSAIDs decrease prostaglandin production and predispose the patient to peptic ulceration. Misoprostol does not reduce gastric acidity, improve emptying of the stomach, or increase lower esophageal sphincter pressure.
A nurse is admitting a patient diagnosed with late-stage gastric cancer. The patients family is distraught and angry that she was not diagnosed earlier in the course of her disease. What factor contributes to the fact that gastric cancer is often detected at a later stage?
- A. Gastric cancer does not cause signs or symptoms until metastasis has occurred.
- B. Adherence to screening recommendations for gastric cancer is exceptionally low.
- C. Early symptoms of gastric cancer are usually attributed to constipation.
- D. The early symptoms of gastric cancer are usually not alarming or highly unusual.
Correct Answer: D
Rationale: Symptoms of early gastric cancer, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms are rarely a cause for alarm or for detailed diagnostic testing. Symptoms precede metastasis, however, and do not include constipation.
A patient who is obese is exploring bariatric surgery options and presented to a bariatric clinic for preliminary investigation. The nurse interviews the patient, analyzing and documenting the data. Which of the following nursing diagnoses may be a contraindication for bariatric surgery?
- A. Disturbed Body Image Related to Obesity
- B. Deficient Knowledge Related to Risks and Expectations of Surgery
- C. Anxiety Related to Surgery
- D. Chronic Low Self-Esteem Related to Obesity
Correct Answer: B
Rationale: It is expected that patients seeking bariatric surgery may have challenges with body image and self-esteem related to their obesity. Anxiety is also expected when facing surgery. However, if the patients knowledge remains deficient regarding the risks and realistic expectations for surgery, this may show that the patient is not an appropriate surgical candidate.
A nurse is performing the admission assessment of a patient whose high body mass index (BMI) corresponds to class III obesity. In order to ensure empathic and patient-centered care, the nurse should do which of the following?
- A. Examine ones own attitudes towards obesity in general and the patient in particular.
- B. Dialogue with the patient about the lifestyle and psychosocial factors that resulted in obesity.
- C. Describe ones own struggles with weight gain and weight loss to the patient.
- D. Elicit the patients short-term and long-term goals for weight loss.
Correct Answer: A
Rationale: Studies suggest that health care providers, including nurses, harbor negative attitudes towards obese patients. Nurses have a responsibility to examine these attitudes and change them accordingly. This is foundational to all other areas of assessing this patient.