Nokea
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.
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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 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.
A community health nurse is preparing for an initial home visit to a patient discharged following a total gastrectomy for treatment of gastric cancer. What would the nurse anticipate that the plan of care is most likely to include?
- A. Enteral feeding via gastrostomy tube (G tube)
- B. Gastrointestinal decompression by nasogastric tube
- C. Periodic assessment for esophageal distension
- D. Monthly administration of injections of vitamin B12
Correct Answer: D
Rationale: Since vitamin B12 is absorbed in the stomach, the patient requires vitamin B12 replacement to prevent pernicious anemia. A gastrectomy precludes the use of a G tube. Since the stomach is absent, a nasogastric tube would not be indicated. As well, this is not possible in the home setting. Since there is no stomach to act as a reservoir and fluids and nutrients are passing directly into the jejunum, distension is unlikely.
A nurse is completing a health history on a patient whose diagnosis is chronic gastritis. Which of the data should the nurse consider most significantly related to the etiology of the patients health problem?
- A. Consumes one or more protein drinks daily.
- B. Takes over-the-counter antacids frequently throughout the day.
- C. Smokes one pack of cigarettes daily.
- D. Reports a history of social drinking on a weekly basis.
Correct Answer: C
Rationale: Nicotine reduces secretion of pancreatic bicarbonate, which inhibits neutralization of gastric acid and can underlie gastritis. Protein drinks do not result in gastric inflammation. Antacid use is a response to experiencing symptoms of gastritis, not the etiology of gastritis. Alcohol ingestion can lead to gastritis; however, this generally occurs in patients with a history of consumption of alcohol on a daily basis.
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.