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A patient who is obese is exploring bariatric surgery options and presented to a bariatric clinic for preliminary investigation. The nurse interviews the patient, analyzing and documenting the data. Which of the following nursing diagnoses may be a contraindication for bariatric surgery?
- A. Disturbed Body Image Related to Obesity
- B. Deficient Knowledge Related to Risks and Expectations of Surgery
- C. Anxiety Related to Surgery
- D. Chronic Low Self-Esteem Related to Obesity
Correct Answer: B
Rationale: It is expected that patients seeking bariatric surgery may have challenges with body image and self-esteem related to their obesity. Anxiety is also expected when facing surgery. However, if the patients knowledge remains deficient regarding the risks and realistic expectations for surgery, this may show that the patient is not an appropriate surgical candidate.
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A patient with gastritis required hospital treatment for an exacerbation of symptoms and receives a subsequent diagnosis of pernicious anemia due to malabsorption. When planning the patients continuing care in the home setting, what assessment question is most relevant?
- A. Does anyone in your family have experience at giving injections?
- B. Are you going to be anywhere with strong sunlight in the next few months?
- C. Are you aware of your blood type?
- D. Do any of your family members have training in first aid?
Correct Answer: A
Rationale: Patients with malabsorption of vitamin B12 need information about lifelong vitamin B12 injections; the nurse may instruct a family member or caregiver how to administer the injections or make arrangements for the patient to receive the injections from a health care provider. Questions addressing sun exposure, blood type, and first aid are not directly relevant.
A nurse is presenting a class at a bariatric clinic about the different types of surgical procedures offered by the clinic. When describing the implications of different types of surgeries, the nurse should address which of the following topics? Select all that apply.
- A. Specific lifestyle changes associated with each procedure
- B. Implications of each procedure for eating habits
- C. Effects of different surgeries on bowel function
- D. Effects of various bariatric surgeries on fertility
- E. Effects of different surgeries on safety of future immunizations
Correct Answer: A,B,C
Rationale: Different bariatric surgical procedures entail different lifestyle modifications; patients must be well informed about the specific lifestyle changes, eating habits, and bowel habits that may result from a particular procedure. Bariatric surgeries do not influence the future use of immunizations or fertility, though pregnancy should be avoided for 18 months after bariatric surgery.
A nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The patient has recently been prescribed misoprostol (Cytotec). What would the nurse be most accurate in informing the patient about the drug?
- A. It reduces the stomachs volume of hydrochloric acid
- B. It increases the speed of gastric emptying
- C. It protects the stomachs lining
- D. It increases lower esophageal sphincter pressure
Correct Answer: C
Rationale: Misoprostol is a synthetic prostaglandin that, like prostaglandin, protects the gastric mucosa. NSAIDs decrease prostaglandin production and predispose the patient to peptic ulceration. Misoprostol does not reduce gastric acidity, improve emptying of the stomach, or increase lower esophageal sphincter pressure.
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 has been diagnosed with peptic ulcer disease and the nurse is reviewing his prescribed medication regimen with him. What is currently the most commonly used drug regimen for peptic ulcers?
- A. Bismuth salts, antivirals, and histamine-2 (H2) antagonists
- B. H2 antagonists, antibiotics, and bicarbonate salts
- C. Bicarbonate salts, antibiotics, and ZES
- D. Antibiotics, proton pump inhibitors, and bismuth salts
Correct Answer: D
Rationale: Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton pump inhibitors, and bismuth salts that suppress or eradicate H. pylori. H2 receptor antagonists are used to treat NSAID-induced ulcers and other ulcers not associated with H. pylori infection, but they are not the drug of choice. Bicarbonate salts are not used. ZES is the Zollinger-Ellison syndrome and not a drug.