Nokea
Which of the following information is best for the nurse to include when teaching a patient with peptic ulcer disease (PUD) about dietary management of the disease?
- A. Avoid foods that cause pain after you eat them.
- B. High-protein foods are least likely to cause pain.
- C. You will need to remain on a bland diet indefinitely.
- D. You should avoid eating many raw fruits and vegetables.
Correct Answer: A
Rationale: The best information is that each individual should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa; however, some patients tolerate by chewing well. High-protein foods not only help to neutralize acid but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little scientific evidence to support their use.
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A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. Which of the following information should the nurse include in the teaching plan?
- A. Substitution of acetaminophen for the NSAID
- B. Use of enteric-coated NSAIDs to reduce gastric irritation
- C. Reasons for using corticosteroids to treat the rheumatoid arthritis
- D. The benefits of misoprostol in protecting the gastrointestinal (GI) mucosa
Correct Answer: D
Rationale: Misoprostol, a prostaglandin analogue, reduces acid secretion and incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating the patient's rheumatoid arthritis.
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 caring for a patient who has been NPO during treatment for nausea and vomiting caused by gastric irritation and is to start oral intake. Which of the following menu choices should the nurse offer to the patient?
- A. A glass of orange juice
- B. A dish of lemon gelatin
- C. A cup of coffee with cream
- D. A bowl of hot chicken broth
Correct Answer: B
Rationale: Clear liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.
To decrease the risk for cancers of the tongue and buccal mucosa, which of the following information should the nurse include when teaching a patient who is seen for an annual physical examination in the outpatient clinic?
- A. Avoid use of cigarettes and smokeless tobacco.
- B. Use sunscreen when outside even on cloudy days.
- C. Complete antibiotics used to treat throat infections.
- D. Use antivirals to treat herpes simplex virus (HSV) infections.
Correct Answer: A
Rationale: Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase risk for oral cancer, although persistent irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with increased risk, but HSV infection is not a risk factor for oral cancer.
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.