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The nurse is teaching a patient with gastroesophageal reflux disease (GERD) about the medication omeprazole. Which of the following information should the nurse include when teaching the patient about this medication?
- A. It neutralizes stomach acid and provides relief of symptoms in a few minutes.
- B. It reduces the reflux of gastric acid by increasing motility.
- C. It coats and protects the lining of the stomach and esophagus from gastric acid.
- D. It treats gastroesophageal reflux disease by decreasing stomach acid production.
Correct Answer: D
Rationale: Omeprazole is a proton pump inhibitor that decreases the rate of gastric acid secretion. Promotility drugs such as metoclopramide increase the rate of gastric emptying. Cytoprotective medications such as sucralfate protect the stomach. Antacids neutralize stomach acid and work rapidly.
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The health care provider prescribes the following therapies for a patient who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order should the nurse implement first?
- A. Infuse normal saline at 250 ml/hour.
- B. Administer IV ondansetron.
- C. Provide oral care with moistened swabs.
- D. Insert a nasogastric (NG) tube.
Correct Answer: A
Rationale: Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished as quickly as possible after the IV fluids are initiated.
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.
Which of the following symptoms should the nurse anticipate in a patient with a duodenal ulcer?
- A. Decreased gastric secretion
- B. Nausea and vomiting
- C. Pain about 1 hour after a meal
- D. Middle of the night pain
- E. Relief from pain with administration of an antacid
Correct Answer: B,D,E
Rationale: A patient with a duodenal ulcer may have nausea and vomiting, pain in the middle of the night, and relief from pain with an administration of an antacid. Decreased gastric secretion is not typical; duodenal ulcers are often associated with increased acid secretion.
The nurse is caring for a patient with deep partial-thickness burns who is anxious about the upcoming dressing change, is in severe pain, and is nauseated. Which of the following actions will be most useful in decreasing the patient's nausea?
- A. Keep the patient NPO for 2 hours before and after dressing changes.
- B. Avoid performing dressing changes close to the patient's mealtimes.
- C. Administer the prescribed morphine sulphate before dressing changes.
- D. Give the ordered prochlorperazine before dressing changes.
Correct Answer: C
Rationale: The patient's nausea is associated with stress and severe pain, therefore the best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea or vomiting that occurs at other times also should be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient's nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain.
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.