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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.
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A nurse is caring for a patient who just has been diagnosed with a peptic ulcer. When teaching the patient about his new diagnosis, how should the nurse best describe a peptic ulcer?
- A. Inflammation of the lining of the stomach
- B. Erosion of the lining of the stomach or intestine
- C. Bleeding from the mucosa in the stomach
- D. Viral invasion of the stomach wall
Correct Answer: B
Rationale: A peptic ulcer is erosion of the lining of the stomach or intestine. Peptic ulcers are often accompanied by bleeding and inflammation, but these are not the definitive characteristics.
A patient has experienced symptoms of dumping syndrome following bariatric surgery. To what physiologic phenomenon does the nurse attribute this syndrome?
- A. Irritation of the phrenic nerve due to diaphragmatic pressure
- B. Chronic malabsorption of iron and vitamins A and C
- C. Reflux of bile into the distal esophagus
- D. A sudden release of peptides
Correct Answer: D
Rationale: For many years, it had been theorized that the hypertonic gastric food boluses that quickly transit into the intestines drew extracellular fluid from the circulating blood volume into the small intestines to dilute the high concentration of electrolytes and sugars, resulting in symptoms. Now, it is thought that this rapid transit of the food bolus from the stomach into the small intestines instead causes a rapid and exuberant release of metabolic peptides that are responsible for the symptoms of dumping syndrome. It is not a result of phrenic nerve irritation, malabsorption, or bile reflux.
A nurse is preparing to discharge a patient after recovery from gastric surgery. What is an appropriate discharge outcome for this patient?
- A. The patients bowel movements maintain a loose consistency.
- B. The patient is able to tolerate three large meals a day.
- C. The patient maintains or gains weight.
- D. The patient consumes a diet high in calcium.
Correct Answer: C
Rationale: Expected outcomes for the patient following gastric surgery include ensuring that the patient is maintaining or gaining weight (patient should be weighed daily), experiencing no excessive diarrhea, and tolerating six small meals a day. Patients may require vitamin B12 supplementation by the intramuscular route and do not require a diet excessively rich in calcium.
A nurse is admitting a patient diagnosed with late-stage gastric cancer. The patients family is distraught and angry that she was not diagnosed earlier in the course of her disease. What factor contributes to the fact that gastric cancer is often detected at a later stage?
- A. Gastric cancer does not cause signs or symptoms until metastasis has occurred.
- B. Adherence to screening recommendations for gastric cancer is exceptionally low.
- C. Early symptoms of gastric cancer are usually attributed to constipation.
- D. The early symptoms of gastric cancer are usually not alarming or highly unusual.
Correct Answer: D
Rationale: Symptoms of early gastric cancer, such as pain relieved by antacids, resemble those of benign ulcers and are seldom definitive. Symptoms are rarely a cause for alarm or for detailed diagnostic testing. Symptoms precede metastasis, however, and do not include constipation.
A patient has come to the clinic complaining of pain just above her umbilicus. When assessing the patient, the nurse notes Sister Mary Josephs nodules. The nurse should refer the patient to the primary care provider to be assessed for what health problem?
- A. A GI malignancy
- B. Dumping syndrome
- C. Peptic ulcer disease
- D. Esophageal/gastric obstruction
Correct Answer: A
Rationale: Palpable nodules around the umbilicus, called Sister Mary Josephs nodules, are a sign of a GI malignancy, usually a gastric cancer. This would not be a sign of dumping syndrome, peptic ulcer disease, or esophageal/gastric obstruction.