Nokea
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.
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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 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 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.
A patient has been admitted to the hospital after diagnostic imaging revealed the presence of a gastric outlet obstruction (GOO). What is the nurses priority intervention?
- A. Administration of antiemetics
- B. Insertion of an NG tube for decompression
- C. Infusion of hypotonic IV solution
- D. Administration of proton pump inhibitors as ordered
Correct Answer: B
Rationale: In treating the patient with gastric outlet obstruction, the first consideration is to insert an NG tube to decompress the stomach. This is a priority over fluid or medication administration.
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.