Nokea
A patient who underwent gastric banding 3 days ago is having her diet progressed on a daily basis. Following her latest meal, the patient complains of dizziness and palpitations. Inspection reveals that the patient is diaphoretic. What is the nurses best action?
- A. Insert a nasogastric tube promptly.
- B. Reposition the patient supine.
- C. Monitor the patient closely for further signs of dumping syndrome.
- D. Assess the patient for signs and symptoms of aspiration.
Correct Answer: C
Rationale: The patients symptoms are characteristic of dumping syndrome, which results in a sensation of fullness, weakness, faintness, dizziness, palpitations, diaphoresis, cramping pains, and diarrhea. Aspiration is a less likely cause for the patients symptoms. Supine positioning will likely exacerbate the symptoms and insertion of an NG tube is contraindicated due to the nature of the patients surgery.
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A patient presents to the walk-in clinic complaining of vomiting and burning in her mid-epigastria. The nurse knows that in the process of confirming peptic ulcer disease, the physician is likely to order a diagnostic test to detect the presence of what?
- A. Infection with Helicobacter pylori
- B. Excessive stomach acid secretion
- C. An incompetent pyloric sphincter
- D. A metabolic acid-base imbalance
Correct Answer: A
Rationale: H. pylori infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen. Excessive stomach acid secretion leads to gastritis; however, peptic ulcers are caused by colonization of the stomach by H. pylori. Sphincter dysfunction and acid-base imbalances do not cause peptic ulcer disease.
Diagnostic imaging and physical assessment have revealed that a patient with peptic ulcer disease has suffered a perforated ulcer. The nurse recognizes that emergency interventions must be performed as soon as possible in order to prevent the development of what complication?
- A. Peritonitis
- B. Gastritis
- C. Gastroesophageal reflux
- D. Acute pancreatitis
Correct Answer: A
Rationale: Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. Chemical peritonitis develops within a few hours of perforation and is followed by bacterial peritonitis. Gastritis, reflux, and pancreatitis are not acute complications of a perforated ulcer.
A nurse is performing the admission assessment of a patient whose high body mass index (BMI) corresponds to class III obesity. In order to ensure empathic and patient-centered care, the nurse should do which of the following?
- A. Examine ones own attitudes towards obesity in general and the patient in particular.
- B. Dialogue with the patient about the lifestyle and psychosocial factors that resulted in obesity.
- C. Describe ones own struggles with weight gain and weight loss to the patient.
- D. Elicit the patients short-term and long-term goals for weight loss.
Correct Answer: A
Rationale: Studies suggest that health care providers, including nurses, harbor negative attitudes towards obese patients. Nurses have a responsibility to examine these attitudes and change them accordingly. This is foundational to all other areas of assessing this patient.
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 nurse is providing care for a patient who is postoperative day 2 following gastric surgery. The nurses assessment should be planned in light of the possibility of what potential complications? Select all that apply.
- A. Malignant hyperthermia
- B. Atelectasis
- C. Pneumonia
- D. Metabolic imbalances
- E. Chronic gastritis
Correct Answer: B,C,D
Rationale: After surgery, the nurse assesses the patient for complications secondary to the surgical intervention, such as pneumonia, atelectasis, or metabolic imbalances resulting from the GI disruption. Malignant hyperthermia is an intraoperative complication. Chronic gastritis is not a surgical complication.