Nokea
A patient presents at the walk-in clinic complaining of recurrent sharp stomach pain that is relieved by eating. The nurse suspects that the patient may have an ulcer. How would the nurse explain the formation and role of acid in the stomach to the patient?
- A. Hydrochloric acid is secreted by glands in the stomach in response to the actual or anticipated presence of food.
- B. As digestion occurs in the stomach, the stomach combines free hydrogen ions from the food to form acid.
- C. The body requires an acidic environment in order to synthesize pancreatic digestive enzymes; the stomach provides this environment.
- D. The acidic environment in the stomach exists to buffer the highly alkaline environment in the esophagus.
Correct Answer: A
Rationale: The stomach, which stores and mixes food with secretions, secretes a highly acidic fluid in response to the presence or anticipated ingestion of food. The stomach does not turn food directly into acid and the esophagus is not highly alkaline. Pancreatic enzymes are not synthesized in a highly acidic environment.
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An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test?
- A. Stool will be yellow for the first 24 hours postprocedure.
- B. The barium may cause diarrhea for the next 24 hours.
- C. Fluids must be increased to facilitate the evacuation of the stool.
- D. Slight anal bleeding may be noted as the barium is passed.
Correct Answer: C
Rationale: Postprocedural patient education includes information about increasing fluid intake; evaluating bowel movements for evacuation of barium; and noting increased number of bowel movements, because barium, due to its high osmolarity, may draw fluid into the bowel, thus increasing the intraluminal contents and resulting in greater output. Yellow stool, diarrhea, and anal bleeding are not expected.
A medical patient's CA 19-9 levels have become available and they are significantly elevated. How should the nurse best interpret this diagnostic finding?
- A. The patient may have cancer, but other GI disease must be ruled out.
- B. The patient most likely has early-stage colorectal cancer.
- C. The patient has a genetic predisposition to gastric cancer.
- D. The patient has cancer, but the site is unknown.
Correct Answer: A
Rationale: CA 19-9 levels are elevated in most patients with advanced pancreatic cancer, but they may also be elevated in other conditions such as colorectal, lung, and gallbladder cancers; gallstones; pancreatitis; cystic fibrosis; and liver disease. A cancer diagnosis cannot be made solely on CA 19-9 results.
A patient is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or assessment finding is the most likely rationale for this examination of intrinsic factor production?
- A. Muscle wasting
- B. Chronic jaundice in the absence of liver disease
- C. The presence of fat in the patient's stool
- D. Persistently low hemoglobin and hematocrit
Correct Answer: D
Rationale: In the absence of intrinsic factor, vitamin B12 cannot be absorbed, and pernicious anemia results. This would result in a marked reduction in hemoglobin and hematocrit.
Results of a patient's preliminary assessment prompted an examination of the patient's carcinoembryonic antigen (CEA) levels, which have come back positive. What is the nurse's most appropriate response to this finding?
- A. Perform a focused abdominal assessment.
- B. Prepare to meet the patient's psychosocial needs.
- C. Liaise with the nurse practitioner to perform an anorectal examination.
- D. Encourage the patient to adhere to recommended screening protocols.
Correct Answer: B
Rationale: CEA is a protein that is normally not detected in the blood of a healthy person; therefore, when detected it indicates that cancer is present, but not what type of cancer is present. The patient would likely be learning that he or she has cancer, so the nurse must prioritize the patient's immediate psychosocial needs, not abdominal assessment. Future screening is not a high priority in the short term.
A nurse in a stroke rehabilitation facility recognizes that the brain regulates swallowing. Damage to what area of the brain will most affect the patient's ability to swallow?
- A. Temporal lobe
- B. Medulla oblongata
- C. Cerebellum
- D. Pons
Correct Answer: B
Rationale: Swallowing is a voluntary act that is regulated by a swallowing center in the medulla oblongata of the central nervous system. Swallowing is not regulated by the temporal lobe, cerebellum, or pons.