Nokea
A patient is receiving education about his upcoming Billroth I procedure (gastroduodenostomy). This patient should be informed that he may experience which of the following adverse effects associated with this procedure?
- A. Persistent feelings of hunger and thirst
- B. Constipation or bowel incontinence
- C. Diarrhea and feelings of fullness
- D. Gastric reflux and belching
Correct Answer: C
Rationale: Following a Billroth I, the patient may have problems with feelings of fullness, dumping syndrome, and diarrhea. Hunger and thirst, constipation, and gastric reflux are not adverse effects associated with this procedure.
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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 patient has come to the clinic complaining of pain just above her umbilicus. When assessing the patient, the nurse notes Sister Mary Josephs nodules. The nurse should refer the patient to the primary care provider to be assessed for what health problem?
- A. A GI malignancy
- B. Dumping syndrome
- C. Peptic ulcer disease
- D. Esophageal/gastric obstruction
Correct Answer: A
Rationale: Palpable nodules around the umbilicus, called Sister Mary Josephs nodules, are a sign of a GI malignancy, usually a gastric cancer. This would not be a sign of dumping syndrome, peptic ulcer disease, or esophageal/gastric obstruction.
A patient was treated in the emergency department and critical care unit after ingesting bleach. What possible complication of the resulting gastritis should the nurse recognize?
- A. Esophageal or pyloric obstruction related to scarring
- B. Uncontrolled proliferation of H. pylori
- C. Gastric hyperacidity related to excessive gastrin secretion
- D. Chronic referred pain in the lower abdomen
Correct Answer: A
Rationale: A severe form of acute gastritis is caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate. Scarring can occur, resulting in pyloric stenosis (narrowing or tightening) or obstruction. Chronic referred pain to the lower abdomen is a symptom of peptic ulcer disease, but would not be an expected finding for a patient who has ingested a corrosive substance. Bacterial proliferation and hyperacidity would not occur.
A nurse is caring for a patient hospitalized with an exacerbation of chronic gastritis. What health promotion topic should the nurse emphasize?
- A. Strategies for maintaining an alkaline gastric environment
- B. Safe technique for self-suctioning
- C. Techniques for positioning correctly to promote gastric healing
- D. Strategies for avoiding irritating foods and beverages
Correct Answer: D
Rationale: Measures to help relieve pain include instructing the patient to avoid foods and beverages that may be irritating to the gastric mucosa and instructing the patient about the correct use of medications to relieve chronic gastritis. An alkaline gastric environment is neither possible nor desirable. There is no plausible need for self-suctioning. Positioning does not have a significant effect on the presence or absence of gastric healing.
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.