Nokea
Cobalamin injections have been prescribed for a patient with persistent atrophic gastritis. Which of the following patient statements indicate that the teaching regarding the injections has been effective?
- A. The cobalamin injections will prevent me from becoming anemic.
- B. These injections will increase the hydrochloric acid in my stomach.
- C. These injections will decrease my risk for developing stomach cancer.
- D. The cobalamin injections need to be taken until my inflamed stomach heals.
Correct Answer: A
Rationale: Cobalamin supplementation prevents the development of pernicious anemia. The incidence of stomach cancer is higher in patients with persistent gastritis, but cobalamin does not reduce the risk for stomach cancer. Persistent gastritis may cause achlorhydria, but cobalamin does not increase hydrochloric acid production or heal stomach inflammation.
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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 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.
The nurse is caring for a patient who has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which of the following nursing actions should be included in the postoperative plan of care?
- A. Elevate the head of the bed to at least 30 degrees.
- B. Reposition the nasogastric (NG) tube if drainage stops or decreases.
- C. Notify the doctor immediately about bloody NG drainage.
- D. Start oral fluids when the patient has active bowel sounds.
Correct Answer: A
Rationale: Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The patient should be in the Fowler's or semi-Fowler's position. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8-12 hours. A swallowing study is needed before oral fluids are started.
The health care provider prescribes intravenous (IV) pantoprazole for a patient with gastrointestinal (GI) bleeding caused by peptic ulcer disease. When teaching the patient about the effect of the medication, which of the following information should the nurse include?
- A. Pantoprazole inhibits some of the stomach cells from pumping stomach acid.
- B. Pantoprazole neutralizes the acid in the stomach.
- C. Pantoprazole constricts the blood vessels in the stomach and decreases bleeding.
- D. Pantoprazole covers the ulcer with a protective material that promotes healing.
Correct Answer: A
Rationale: Pantoprazole is a proton pump inhibitor, which inhibits some of the stomach cells from pumping gastric acid. The response beginning, 'Pantoprazole constricts the blood vessels' describes the effect of vasopressin. The response beginning 'Pantoprazole neutralizes the acid' describes the effect of antacids. And the response beginning 'Pantoprazole covers the ulcer' describes the action of sucralfate.
The nurse is providing discharge teaching for a patient following a gastroduodenostomy for treatment of a peptic ulcer. Which of the following patient statements indicate that the teaching has been effective?
- A. Persistent heartburn is expected after surgery.
- B. I will try to drink liquids along with my meals.
- C. Vitamin supplements may be needed to prevent problems with anemia.
- D. I will need to choose foods that are low in fat and high in carbohydrate.
Correct Answer: C
Rationale: Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery and the patient should call the health care provider if this occurs.