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The nurse is caring for a patient who is nauseated, vomiting up blood-streaked fluid and has acute gastritis. Which of the following assessments should the nurse ask the patient about to determine possible risk factors for gastritis?
- A. The amount of fat in the diet
- B. History of recent weight gain or loss
- C. Any family history of gastric problems
- D. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: D
Rationale: Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.
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After receiving change-of-shift report, which of the following patients should the nurse assess first?
- A. A patient who was admitted yesterday with gastrointestinal (GI) bleeding and has melena
- B. A patient who is crying after receiving a diagnosis of esophageal cancer
- C. A patient with esophageal varices who has a blood pressure of 90/54 mm Hg
- D. A patient with nausea who has a dose of metoclopramide (Reglan) scheduled
Correct Answer: C
Rationale: The patient's history and blood pressure indicate possible hemodynamic instability caused by GI bleeding. The data about the other patients do not indicate acutely life-threatening complications.
A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. Which of the following information should the nurse teach to the patient to avoid recurrence of these symptoms?
- A. Lie down for about 30 minutes after eating.
- B. Choose foods that are high in carbohydrates.
- C. Increase the amount of fluid intake with meals.
- D. Drink sugared fluids or eat candy after each meal.
Correct Answer: A
Rationale: The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.
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.
Which of the following information should the nurse include when teaching a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
- A. Peppermint tea may be helpful in reducing your symptoms.
- B. You should avoid eating between meals to reduce acid secretion.
- C. Vigorous physical activities may increase the incidence of reflux.
- D. It will be helpful to keep the head of your bed elevated on blocks.
Correct Answer: D
Rationale: Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will lower LES pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distension. There is no need to make changes in physical activities because of GERD.
The nurse is caring for an older-adult patient who has been diagnosed with esophageal cancer and the patient tells the nurse, 'I know that my chances are not very good, but I do not feel ready to die yet.' Which of the following responses by the nurse is best?
- A. You may have quite a few years still left to live.
- B. Thinking about dying will only make you feel worse.
- C. Having this new diagnosis must be very hard for you.
- D. It is important that you be realistic about your prognosis.
Correct Answer: C
Rationale: This response is open-ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have only a low survival rate, so the response 'You may have quite a few years still left to live' is misleading. The response beginning, 'Thinking about dying' indicates that the nurse is not open to discussing the patient's fears of dying. And the response beginning, 'It is important that you be realistic,' discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.