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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.
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A nurse is assessing a patient who has peptic ulcer disease. The patient requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the patient?
- A. Most affected patients acquired the infection during international travel.
- B. Infection typically occurs due to ingestion of contaminated food and water.
- C. Many people possess genetic factors causing a predisposition to H. pylori infection.
- D. The H. pylori microorganism is endemic in warm, moist climates.
Correct Answer: B
Rationale: Most peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water. The organism is endemic to all areas of the United States. Genetic factors have not been identified.
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 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 patient comes to the bariatric clinic to obtain information about bariatric surgery. The nurse assesses the obese patient knowing that in addition to meeting the criterion of morbid obesity, a candidate for bariatric surgery must also demonstrate what?
- A. Knowledge of the causes of obesity and its associated risks
- B. Adequate understanding of required lifestyle changes
- C. Positive body image and high self-esteem
- D. Insight into why past weight loss efforts failed
Correct Answer: B
Rationale: Patients seeking bariatric surgery should be free of serious mental disorders and motivated to comply with lifestyle changes related to eating patterns, dietary choices, and elimination. While assessment of knowledge about causes of obesity and its associated risks as well as insight into the reasons why previous diets have been ineffective are included in the clients plan of care, these do not predict positive client outcomes following bariatric surgery. Most obese patients have an impaired body image and alteration in self-esteem. An obese patient with a positive body image would be unlikely to seek this surgery unless he or she was experiencing significant comorbidities.
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.