Nokea
Twelve hours after undergoing a gastroduodenostomy (Billroth II), a patient has symptoms of increasing abdominal pain. The patient has absent bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. Which of the following actions should the nurse take next?
- A. Notify the surgeon.
- B. Irrigate the NG tube.
- C. Administer the prescribed morphine.
- D. Continue to monitor the NG drainage.
Correct Answer: A
Rationale: Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion and/or return to surgery are needed. Because the NG is draining, there is no indication that irrigation is needed. The patient may need morphine, but this is not the highest priority action. Continuing to monitor the NG drainage is not an adequate response.
You may also like to solve these questions
The nurse is counselling a patient with a family history of stomach cancer about risk factors. Which of the following is a risk factor for the development of stomach cancer?
- A. Type A blood
- B. Persistent abdominal distension
- C. Long-term use of H2 blocking medications
- D. Exposure to emotionally or physically stressful situations
Correct Answer: A
Rationale: Patients with Type A blood have an increased risk for stomach cancer. Use of H2 blockers, stressful situations, and abdominal distension are not associated with an increased incidence of stomach cancer.
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.
The nurse is admitting a patient to the emergency department who has had several episodes of bloody diarrhea. Which of the following actions should the nurse anticipate taking?
- A. Obtain a stool specimen for culture.
- B. Administer antidiarrheal medications.
- C. Teach about adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs).
- D. Provide education about antibiotic therapy.
Correct Answer: A
Rationale: Patients with bloody diarrhea should have a stool culture for E. coli O157:H7. NSAIDs may cause occult blood in the stools, but not diarrhea. Antidiarrheal medications usually are avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney 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 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.