Nokea
A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. Which of the following information should the nurse teach to the patient to avoid recurrence of these symptoms?
- A. Lie down for about 30 minutes after eating.
- B. Choose foods that are high in carbohydrates.
- C. Increase the amount of fluid intake with meals.
- D. Drink sugared fluids or eat candy after each meal.
Correct Answer: A
Rationale: The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.
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The nurse is teaching a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications. Which of the following diet choices for a snack 2 hours before bedtime indicates that the teaching has been effective?
- A. Chocolate pudding
- B. Glass of low-fat milk
- C. Peanut butter sandwich
- D. Cherry gelatin and fruit
Correct Answer: D
Rationale: Cherry gelatin and fruit is a suitable choice as it is low in fat and not likely to trigger reflux, unlike chocolate, milk, or high-fat foods like peanut butter, which can exacerbate GERD symptoms.
After receiving change-of-shift report, which of the following patients should the nurse assess first?
- A. A patient who was admitted yesterday with gastrointestinal (GI) bleeding and has melena
- B. A patient who is crying after receiving a diagnosis of esophageal cancer
- C. A patient with esophageal varices who has a blood pressure of 90/54 mm Hg
- D. A patient with nausea who has a dose of metoclopramide (Reglan) scheduled
Correct Answer: C
Rationale: The patient's history and blood pressure indicate possible hemodynamic instability caused by GI bleeding. The data about the other patients do not indicate acutely life-threatening complications.
The family member of a patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine. Which of the following information should the nurse provide to the family about the medication for this patient?
- A. It prevents aspiration of gastric contents.
- B. It inhibits the development of stress ulcers.
- C. It lowers the chance for H. pylori infection.
- D. It decreases the risk for nausea and vomiting.
Correct Answer: B
Rationale: Famotidine is administered to prevent the development of physiological stress ulcers, which are associated with a major physiological insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.
The nurse is caring for a patient with a peptic ulcer and a nasogastric (NG) tube who develops sudden, severe upper abdominal pain, diaphoresis, and a firm, rigid abdomen. Which of the following actions should the nurse take next?
- A. Irrigate the NG tube.
- B. Obtain the vital signs.
- C. Listen for bowel sounds.
- D. Give the ordered antacid.
Correct Answer: B
Rationale: The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. The nurse should assess the bowel sounds, but this is not the first action that should be taken.
The health care provider prescribes antacids and sucralfate for treatment of a patient's peptic ulcer. Which of the following information should the nurse include in the patient's teaching plan?
- A. Antacids 30 minutes before the sucralfate
- B. Sucralfate at bedtime and antacids before meals
- C. Antacids after eating and sucralfate 30 minutes before eating
- D. Sucralfate and antacids together 30 minutes before each meal
Correct Answer: C
Rationale: Sucralfate is most effective when the pH is low and should not be given with or soon after antacid. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.