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The nurse is caring for a patient with peptic ulcer disease associated with the presence of Helicobacter pylori and is being treated with triple drug therapy. Which of the following medications should the nurse include in the patient teaching?
- A. Sucralfate, nystatin, and bismuth
- B. Amoxicillin, clarithromycin, and omeprazole
- C. Famotidine, magnesium hydroxide, and pantoprazole
- D. Metoclopramide, bethanechol, and promethazine
Correct Answer: B
Rationale: The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.
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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 admitting a patient with a stroke who is unconscious and unresponsive, learns from the patient's family that the patient has a history of gastroesophageal reflux disease (GERD). Which of the following assessment parameters should the nurse plan to assess frequently?
- A. Bowel sounds
- B. Pupillary response
- C. Grip strength
- D. Oral mucosa
Correct Answer: D
Rationale: Due to the patient's unconscious state and history of GERD, frequent assessment of the oral mucosa is crucial to monitor for complications such as aspiration or mucosal damage from reflux. Bowel sounds, pupillary response, and grip strength are important but less directly related to GERD complications in this context.
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.
The nurse is caring for a patient with stomach cancer who had a recent 9.1 kg unintended weight loss. Which of the following nursing actions should be included in the plan of care?
- A. Refer the patient for hospice services.
- B. Infuse IV fluids through a central line.
- C. Teach the patient about antiemetic therapy
- D. Offer supplemental feedings between meals.
Correct Answer: D
Rationale: The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusions.
The nurse is caring for a patient with a bleeding duodenal ulcer who has a nasogastric (NG) tube in place and a prescription for 30 mL of aluminum hydroxide/magnesium hydroxide to be instilled through the tube every hour. Which of the following assessments should the nurse do to evaluate the effectiveness of this treatment?
- A. Periodically aspirate and test gastric pH.
- B. Monitor arterial blood gas values on a daily basis.
- C. Check each stool for the presence of occult blood.
- D. Measure the amount of residual stomach contents hourly.
Correct Answer: A
Rationale: The purpose for antacids is to increase gastric pH. Checking gastric pH is the most direct way of evaluating the effectiveness of the medication. Arterial blood gases may change slightly, but this does not directly reflect the effect of antacids on gastric pH. Because the patient has upper gastrointestinal (GI) bleeding, occult blood in the stools will appear even after the acute bleeding has stopped. The amount of residual stomach contents is not a reflection of resolution of bleeding or of gastric pH.