Nokea
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.
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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.
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.
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.
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.
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.