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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.
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A patient with a history of peptic ulcer disease has presented to the emergency department (ED) in distress. What assessment finding would lead the ED nurse to suspect that the patient has a perforated ulcer?
- A. The patient has abdominal bloating that developed rapidly.
- B. The patient has a rigid, boardlike abdomen that is tender.
- C. The patient is experiencing intense lower right quadrant pain.
- D. The patient is experiencing dizziness and confusion with no apparent hemodynamic changes.
Correct Answer: B
Rationale: An extremely tender and rigid (boardlike) abdomen is suggestive of a perforated ulcer. None of the other listed signs and symptoms is suggestive of a perforated ulcer.
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 is recovering in the hospital following gastrectomy. The nurse notes that the patient has become increasingly difficult to engage and has had several angry outbursts at various staff members in recent days. The nurses attempts at therapeutic dialogue have been rebuffed. What is the nurses most appropriate action?
- A. Ask the patients primary care provider to liaise between the nurse and the patient.
- B. Delegate care of the patient to a colleague.
- C. Limit contact with the patient in order to provide privacy.
- D. Make appropriate referrals to services that provide psychosocial support.
Correct Answer: D
Rationale: The nurse should enlist the services of clergy, psychiatric clinical nurse specialists, psychologists, social workers, and psychiatrists, if needed. This is preferable to delegating care, since the patient has become angry with other care providers as well. It is impractical and inappropriate to expect the primary care provider to act as a liaison. It would be inappropriate and unsafe to simply limit contact with the patient.
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 nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When teaching the patient about his new diagnosis, how should the nurse best describe a peptic ulcer?
- A. Inflammation of the lining of the stomach
- B. Erosion of the lining of the stomach or intestine
- C. Bleeding from the mucosa in the stomach
- D. Viral invasion of the stomach wall
Correct Answer: B
Rationale: A peptic ulcer is erosion of the lining of the stomach or intestine. Peptic ulcers are often accompanied by bleeding and inflammation, but these are not the definitive characteristics.