Exam 3 (Ch. 44, 45, & 46) Flashcards
1
Q
Nausea & Vomiting
Nausea is blank (objective or subjective) & is usually accompained by what?
A
Subjective
Anorexia
2
Q
Nausea & Vomiting
What does anorexia mean?
Not E.D.
A
Lack of appetite, an abnormal loss of the appetite for food.
3
Q
Nausea & Vomiting
Persistent vomiting leads to ?(4)
A
- Severe electrolyte imbalance
- Fluid volume loss
- Weight loss
- Eventual ciruclatory failure
4
Q
GERD
What does GERD stand for and what is it?
A
Gastroesophageal Reflux Disease
A symptom of mucosal damage caused by reflux of stomach acid into the lower esophagus
Syndrome, not disease
5
Q
Nausea & Vomiting
What are some treatments for N/V?
A
Antiemetic drugs
Scopolamine transdermal
Ondansetron (Zofran)
Promethazine
Metoclopramide (Reglan)
NPO
Intravenous Fluids
Nutritional therapy
6
Q
Nausea & Vomiting
What will high frequent doses of Metoclopramide (Reglan) lead to?
A
Tardive Dyskinesia (frequent mouth movement)
7
Q
What is the most common upper GI problem?
A
GERD
About 15 million Americans have GERD symptoms each day.
8
Q
GERD
What are some symptoms & complications of GERD?
A
Heartburn
Chest Pain
Dyspepsia
Regurgitation
Wheezing/Coughing
Dyspnea
Hoarseness
Sore Throat
Esophagitis
Barrett Esophagus
Respiratory Complication
9
Q
GERD
What is dyspepsia?
A
Pain or discomfort in the upper abdomen mainly in or around the midline.
10
Q
GERD
What are some diagnostic test for GERD?
A
Endoscopy
Biopsy & cytologic specimens
Motility studies
Ambulatory esophageal pH monitoring
Radionuclide tests
11
Q
GERD
Drug therapy for GERD focuses on what?
A
Decreasing the volume & acidity of reflux
Increasing esophageal clearance
Protecting the esophageal mucosa
12
Q
GERD
What are some medications given for GERD? (6)
A
Esomeprazole (Nexium)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Famotidine (Pepcid)
Calcium carbonate (Tums)
Sucrafate (Carafate)
13
Q
PUD
What does PUD stand for and what is it?
A
Peptic Ulcer Disease
Erosion of GI mucosa from HCl acid and pepsin
14
Q
PUD
What area of the GI tract are susceptible to PUD?
A
Lower esophagus
Stomach
Duodenum
Post-op gastrojejunal anastomosis
15
Q
PUD
PUD is classified by degree and duration of mucosal involvement and by location.
What is Acute and what is Chronic
A
Acute—superficial erosion and minimal inflammation
Chronic—Erosion of muscular wall with formation of fibrous tissue; present continuously for many months or intermittently throughout lifetime – more common
16
Q
Gastric Ulcers
Who is gastric:antrum more prevalent in? What are they at an increased risk for? What are the risk factors? What is the mortality & recurrence rate?
A
More prevalent in females older than 50 years
Increased obstruction
Risk factors: Helicobacter pylori, NSAIDs, bile reflux
Increased mortality
High recurrence
17
Q
Gastric Ulcers
Who is duodenal:1-2cm more prevalent in? What are is the etiology? What do these ulcer cause a high secretion of? What are the risk factors? What is the recurrence rate?
A
Prevalent ages 35 to 45
Etiology: H. pylori
High HCL secretion
High risk: COPD, cirrhosis, pancreatitis, hyperparathyroidism, Zollinger-Ellison syndrome, CRF (Chronic renal failure)
Occur, disappear, recur
18
Q
Risk Factors and Clinical Manifestations
How is H. pylori is transmitted & what does the bacteria produce?
A
Transmission
* From family members to a child
* Oral-oral or fecal-oral
Bacteria produce urease
* Increased gastric section, tissue damage
19
Q
Risk Factors and Clinical Manifestations
What may make someone more susceptible to H. pylori?
A
Medication-Induced Injury
* NSAIDs; especially with Corticosteroids or anticoagulants
Lifestyle factors
20
Q
Risk Factors and Clinical Manifestations
How is a gastric ulcer presented in a pt? What is the first symptom in some pts?
A
Epigastric discomfort 1 to 2 hours after meal; burning or gaseous pain; food may worsen
Perforation is first symptom in some patients
21
Q
Risk Factors and Clinical Manifestations
What might the pain from a duodenal ulcer feel like?
A
Burning or cramplike pain in midepigastric or back; 2 to 5 hours after meal
22
Q
Risk Factors and Clinical Manifestations
What S/S do gastric & duodenal ulcers have in common?
A
Bloating, nausea, vomiting, early feeling of fullness
- May be silent (older adults and NSAIDs)
23
Q
Gastric Ulcers: Diagnostic Studies
What are some diagnositc studies for gastric ulcers?
A
Endoscopy
- Obtain specimens for H. pylori Rule out stomach cancer
Biopsy of antral mucosa w/testing for urease
* Gold standard for H. pylori
Non-invasive tests: serology, stool, breath testing
Other tests: barium contrast, high fasting serum gastrin levels, secretin stimulation
Labs: CBC, liver enzymes, serum amylase
Stool is tested for blood
24
Q
Gastric Ulcer: Interprofessional Management
What are some key parts of drug therapy gastic ulcer treatment?
A
Reduce gastric acid secretion (PPI)
Eliminate H. pylori (antibiotics and PPI)
Patient education: adherence important; teach about drugs; report recurrence of pain or blood in vomitus or stool
25
# Gastric Ulcer: Interprofessional Management
What antibiotic therapy to eradicate *H. pylori* is used?
14 days of PCN with PPI
If allergic to PCN, metronidazole used
Bismuth alone or combined with tetracycline and metronidazole
26
# Gastric Ulcer: Interprofessional Management
Why are proton pump inhibitors used to treat gastric ulcers?
More effective than H2-receptor blockers; as previously noted, used with antibiotics to treat H. pylori
27
# Gastric Ulcer: Interprofessional Management
Why are cytoprotective drug therapy- Sucralfate used to treat gastric ulcers? What does it bind with?
Protects esophagus, stomach, and duodenum
Works best in low pH; give at least 1 hour before or after antacid
Binds with cimetidine, digoxin, warfarin, phenytoin, and tetracycline to reduce their bioavailability
28
# Etiology and Pathophysiology
Where do oral cavity cancer and oropharyngeal cancer develop?
Oral Cavity Cancer: Cancer that develops in the mouth.
Oropharyngeal Cancer: Cancer that develops in the oropharynx (the part of the throat just behind the mouth).
29
# Etiology and Pathophysiology
Where are the common sites for head & neck squamous cell carcinoma (HNSCC)? What is the common age & gender? What is the most favorable type
## Footnote
Broad term for cancers of oral cavity, pharynx and larynx
Common sites: lower lip, under or sides of tongue, labial commissure, buccal mucosa
More common after age 35 with average age of diagnosis at 65 years old
2 times more common in men
Visible lip cancer has most favorable
30
# Oral Cancer: Clinical Manifestations
What are some common manifestations of oral cancer?
Chronic sore throat, sore mouth, voice changes, ulcers, dysphagia, & slurred speech
- Later: increased saliva, toothache, & earache
31
# Oral Cancer: Clinical Manifestations
What is leukoplakia?
| Precancerous Lesions
White, thickened patches on the mucous membranes of the mouth.
Often caused by smoking.
Can become hyperkeratosis (thickening of the skin).
32
# Oral Cancer: Clinical Manifestations
What is erythroplakia?
| Precancerous Lesions
Red, velvety lesions on the mucous membranes of the mouth.
Often progresses to squamous cell carcinoma (cancer).
33
# Oral Cancer: Diagnostic Studies
What are some common diagnostic studies of oral cancer?
Oral dysplasia – precursor to oral cancer
Oral exfoliative cytology—scraping
Toludine blue test—screening
Cancer cells take up topically applied dye
Negative results do not rule out cancer
CT, MRI, PET for staging
34
# Oral Cancer: Interprofessional Management
What are some radical surgical interventions for oral cancer?
* Partial Mandibulectomy: Removal of a portion of the lower jawbone (mandible).
* Hemiglossectomy: Removal of half of the tongue.
* Glossectomy: Removal of the entire tongue.
* Resections of Buccal Mucosa and Floor of Mouth: Removal of parts of the cheek lining and the floor of the mouth.
* Radical Neck Dissection: Removal of lymph nodes and surrounding tissue in the neck.
| Minimally invasive robotic surgery is also an optione
35
# Oral Cancer: Interprofessional Management
What are some nonsurgical interventions for oral cancer?
Radiation
Chemotherapy
Palliative
Nutritional
PEG tube, enteral feedings
36
# Oral Cancer: Clinical Problems and Planning
What are 3 main clinical problems of oral cancer?
- Nutritionally compromised
- Pain
- Difficulty Coping
37
# Oral Cancer: Clinical Problems and Planning
What are the 4 main goals of oral cancer care/planning?
- Patent Airway
- Able to Communicate
- Adequate Intake to Maintain Nutrition
- Relief of Pain & Discomfort
38
# Oral Cancer: Implementation and Evaluation
What are some health promotion/implementation for oral cancer?
- Identify patients at risk
- Good oral hygiene
- Smoking cessation
- Early detection
39
# Oral Cancer: Implementation and Evaluation
When evaluating the implementations/interventions of oral cancer, what would indicate success? (4)
* No respiratory complications
* Able to communicate
* Adequate nutrition
* Minimal pain
40
# Upper GI Bleeding: Etiology and Pathophysiology
What are the 3 types of GI bleeding?
## Footnote
Most serious loss of blood has a sudden onset
Hematemesis—bloody vomitus
- Bright red
- Coffee-ground—contact with HCl acid; digested blood
Melena—black, tarry stools from upper GI source
Occult—guaiac test detects blood in gastric secretions, vomitus, or stool
41
# Upper GI Bleeding: Diagnostic Studies
What are some diagnostic studies used for upper GI bleeding?
- Endoscopy (primary tool for discovering source)
- Angiography (not high-risk/unstable)
- Labs (CBC, BUN, plus others)
- Vomitus & stool
- Assess for shock
- Monitor urine output hourly (one of the best measures of vital organ perfusion)
| Labs:serum electrolytes, PT, PTT, liver enzymes, ABGs, type & crossmatch
42
# Upper GI Bleeding: Diagnostic Studies
How much blood lost would indicate a massive GI bleed?
greater than 1500 mL blood loss or 25% intravascular blood volume
- 80% to 85% stop spontaneously; still need treatment
43
# GI bleed: Nursing Management: Implementation
What are some aspects of GI bleed nursing management?
Assess/monitor circulation, airway, breathing
IV access—Two large bore
- IV fluids, PPIs, and blood
Oxygen, ECG monitoring, VS, LOC
Labs: CBC, clotting studies, type and crossmatch
NGT, urinary catheter; I & O
Abdomen, bowel sounds, NPO
Older adult: watch fluid overload
44
# GI bleed: Nursing Management: Implementation
What are some aspects of acute care for GI bleeds?
NGT management: proper position, assess aspirate for blood
- Lavage: 50 to 100 mL instilled and drained
Assess stool and vomitus for blood
Oral intake: monitor nausea and vomiting
- Clear liquids—advance as tolerated
Alcohol use disorder—monitor for withdrawal; delirium tremens
45
# Enteral Nutrition
What are some indications for enteral nutrition?
Anorexia
Orofacial fractures
Head/neck cancer
Neurologic or psychiatric conditions
Extensive burns
Critical illness
Chemotherapy
Radiation therapy
46
# Enteral Nutrition
What are some contraindications for enteral nutrition?
GI obstruction
Prolonged ileus
Severe diarrhea or vomiting
Enterocutaneous fistula
47
# Enteral Nutrition
What are some delivery options for enteral nutrition & what does the type depend on?
Delivery options include:
* Continuous infusion or intermittent (bolus) by pump
* Bolus by gravity
* Bolus by syringe
Type depends on:
* Anticipated length of time EN needed
* Risk for aspiration
* Patient’s clinical status
* Adequacy of digestion and absorption
48
# Enteral Nutrition
What are some disadvantages of naso-intestinal tubes?
* Can clog easily
* Harder to use for checking residual
* Prone to occlusion with medication administration
* Can be dislodged by vomiting or coughing
* Can become knotted/kinked in GI tract
49
# Enteral Nutrition
Which of the following is a requirement for PEG placement?
A. A fully intact gag reflex
B. An esophageal lumen wide enough for an endoscope
C. A history of previous abdominal surgery
D. The ability to tolerate a high-fiber diet
B. An esophageal lumen wide enough for an endoscope
Rationale: The endoscope needs to pass through the esophagus to reach the stomach.
50
# Enteral Nutrition
Which of the following are advantages of PEG and radiologically placed gastrostomy compared to surgical placement? (Select all that apply)
A. Higher cost
B. Fewer risks
C. Requires general anesthesia
D. Minimal sedation
E. Faster recovery time
B, D, E
Rationale: PEG and radiologically placed gastrostomy have lower costs and often don't require general anesthesia.
51
# Enteral Nutrition
A patient has just undergone PEG placement. When can the nurse expect to start tube feedings?
A. Immediately after the procedure
B. When bowel sounds are present, usually within 24 hours
C. After 3-5 days of bowel rest
D. Only when the patient is fully awake and alert
B. When bowel sounds are present, usually within 24 hours
Rationale: Bowel sounds indicate the return of gastrointestinal function.
52
# Enteral Nutrition
A patient with a PEG tube is scheduled to take medicine that needs to be administered on an empty stomach. Which of the following actions should the nurse take?
A. Administer the medication immediately before starting a tube feeding.
B. Hold the tube feeding for at least 30 minutes before administering the medication.
C. Crush the medication and mix it with the tube feeding formula.
D. Administer the medication through a separate IV line.
B. Hold the tube feeding for at least 30 minutes before administering the medication.
Rationale: This ensures the medication is administered on an empty stomach as prescribed.
53
# Enteral Nutrition
Which of the following assessments are important for a patient with a newly placed PEG tube? (Select all that apply)
A. Monitor for signs of infection at the insertion site.
B. Assess for proper placement of the tube.
C. Check for any leakage of gastric contents around the tube.
D. Evaluate the patient's tolerance of tube feedings.
E. Educate the patient and family on PEG tube care and maintenance.
A, B, C, D, E
Rationale: All of these assessments are crucial to ensure the safety and effectiveness of PEG tube feeding.
54
# Enteral Nurtition
How do you check for tube patency?
Flush feeding tube with 30 mL warm water every 4 hours for continuous tube feeding
Flush with water before/after each bolus feeding and drug administration
Continuous feedings administered on feeding pump with occlusion alarm
55
# Enteral Nutrition
What are misconnections?
Inadvertent connection between an enteral feeding system and a nonenteral feeding system
- IV line, peritoneal dialysis catheter, tracheostomy tube cuff
Severe patient injury or death can result
55
# Parenteral Nutrition
What is parenteral nutrition, when is it used, & what are its goals?
Administration of nutrients directly into the bloodstream
Used when GI tract cannot be used for ingestion, digestion, and absorption
Goal: Meet nutrition needs and allow growth of new body tissue
| Customized to meet each patient’s needs
56
# PN Indications
What are some PN indications?
- Chronic severe diarrhea & vomiting
- Complicated surgery or trauma
- GI obstruction
- GI tract anomalies & fistulae
- Intractable diarrhea
- Severe anorexia nervosa
- Severe malabsorpation
- Short bowel syndrome
56
# PN Composition
What are 3 type of PN solutions?
1. Base Soultions: Dextrse & Amino Acids
2. 3-in-1: IV Fat Emulsions, Dextrose, & Amino Acids
3. Customization: Prescribed electrolytes, vitamins, and trace elements are added to the base solution or TNA to customize the PN to meet the patient's specific needs.
57
# Parenteral Nutrition Administration
What is central parenteral nutrition used for? Where is central PN placed? What is its tonicity
Long-term support
High protein & caloric requirements
Tip lies in superiot vena cava
- Subclavian or jugular vein
- Peripherally inserted central catheters (PICCs)
- Long-term parenteral support
Hypertonic
- Large central vein can handle high glycose content ranging form 20-50%
58
# Prenteral Nutrition Administration
What is peripheral parenteral nutrition (PPN) used for? What is its toncity?
Short-term therapy or special conditions
Less hypertonic than central PN
- Peripheral vein can handle glucose up to 20%
59
# Prenteral Nutrition Administration
Who can perpare PN solutions? How are they stored? How are they labled?
Perpated by a pharmacist or trained technician under strict aspect techniques
Muts be refirgerated until 30 min before use
Must be labled with nutrient content, all additive, time mixed, & date & time of expiration
| Be sure to verify pt. name on labled before admin
60
# PN
What are the 2 main PN complications?
1. Refeeding syndrome
- Fluid retention & electrolyte imbalances
- **Hypophosphatemia is hallmark**
- Pts. predisposed by long-standing malnutrition states
2. Metabolic problems
- Altered renal function
- Essential fatty acid deficiency
- Hyper/hypoglycemia
- Hyperlipidemia
- Liver dysfunction
61
# PN
What are some catheter-related problems associated with PN?
- Air embolus
- Catheter-related sepsis
- Dislodgement, thrombosis of vein, phlebitis
- Hemorrhage, Occlusion
- Pneumothorax, Hemothorax, Hydrothorax
62
# PN Nursing Management
What are the "5 steps" to PN nursing management?
1. Check: before starting PN, check label & ingredients against order
2. Examine: examine bag for signs of contamination
3. Discontinue: discontinue PN solution at end of 24 hrs
4. Change: change tubing q24h
5. Watch: watch for infection & septicemia
Local manifestations
Systemic manifestations
| Check to ensure bag is for the right pt.
63
# PN Nursing Management
What should the nurse teach the pt/caregiver about PN before discharge?
Catheter or tube care
Mixing & handling of solutions & tube
Side effects & complications
64
# Bariatric Surgery
What is bariatric surgery? What is it used to treat?
Surgery on the stomach and/or intestines
Currently only treatment found to have a successful and lasting impact on sustained weight loss for those with extreme obesity
65
# Bariatric Surgery
What is the criteria for bariatric surgery?
| BMIs & comorbidities
BMI ≥40 kg/m2
BMI ≥35 kg/m2 with at least 1 weight related comorbidities
- Hypertension, type 2 diabetes, heart failure, sleep apnea, liver failure
66
# Retrictive Surgery
What does an adjustable gastric banding (AGB) do? How is the band connected?
What: Limits stomach size with an inflatable band around fundus of the stomach
How: Connected to a subcutaneous port that can be inflated or deflated to meet patient’s needs as weight is lost
Band creates sense of fullness
| Can be modified or reversed at later date
67
# Restricitve Surgery
What type pt. is adjestable gastric banding preferred for?
Preferred for patients who are surgical risk
- Done laparoscopically
68
# Sleeve Gastrectomy
How is sleeve gastrectomy done?
75% of the stomach is removed
* Not reversible
* Stomach function is preserved
* Results in elimination of hormones produced in the stomach that stimulate hunger
Ghrelin
69
# Sleeve Gastrectomy
How is endoscopic sleeve gastroplasty done?
Minimally invasive
Sutures placed endoscopically in stomach
70
# Combination of Restrictive and Malabsorptive Surgery
How are Roux-en-Y surgical procedure (RYGB) preformed?
Small gastric pouch created and attached directly to small intestine
Food bypasses 90% of the stomach, duodenum, and a small segment of jejunum
71
# Combination of Restrictive and Malabsorptive Surgery
What are some complication of Roux-en-Y surgical procedure (RYGB)?
GI tract leaks
Gastric remnant distention
Ulcers
Gallstones
Hernias
72
# Combination of Restrictive and Malabsorptive Surgery
Dumping syndrome is a complication of the RYGB, how does it occur, what are some symptoms?
Gastric contents empty too rapidly into small intestine
Symptoms include vomiting, nausea, weakness, sweating, fainting, occasionally diarrhea
Avoidance of sugary foods is recommended
73
# Gastric Pacemaker
How is a gastric pacemaker implanted and how does it work?
| Also known as gastric electrical stimulation
Implantable device surgically placed with leads and wires around vagus nerve
Controls nerve impulses from brain to stomach
Device sends signals to block vagus nerve impulses
- Decreased hunger, increased satiety
External controller allow charging of device and adjusting settings
74
# Pre-Operative and Post-Operative Care
What should be determined before a pt. undergoes bariatric surgery? What should be coordinated before surgery?
Determine:
* Assistive devices currently in use
* Past and current health information
* Co-morbidities increase risk of complications
Coordinate: Cardiologist, pulmonologist, gynecologist, gastroenterologist, or other specialists
75
# Pre-Operative and Post-Operative Care
What should be in the room after a pt. undergoes bariatric surgery? What should you have the pt. do?
Appropriate size bed
* Larger BP cuff
* Larger gown
* Patient transfer equipment
* Wheelchair with removable arms
Practice Coughing, Deep breathing, turning and positioning
* Arrange for CPAP if used at home
* Incentive Spirometer Use
76
# Postoperative Care
How should you transfer a pt. post bariatric surgery?
Transfer with specially trained personnel
* Stabilize airway
* Manage pain
* Keep HOB elevated
77
# Postoperative Care
What are some important aspects of post bariatric surgery pt. care?
Evaluate for signs of re-sedation
Administer O2 therapy as needed
Implement venous thromboembolism (VTE) precautions
Diligent turning and ambulating
Assess skin, including skinfolds
* Infection, dehiscence, delayed healing
* Implement measures to reduce risk of pressure injury
78
# Special Considerations Postoperative Care
What is postprandial hypoglycemia and what causes?
blood sugar drops after meal (within 4 hours of eating)
This is due to rapid emptying of food from the stomach into the small intestine, leading to an exaggerated insulin response.
79
# Special Considerations Postoperative Care
What should the nurse do when a pt., post bariatric surgery, considerable abdominal pain?
Give medication as needed
Assess for anastomosis leaks
Evaluate wound condition closely
Careful transition to new diet
* Low-sugar, clear-liquid within 24 hours
* Goal of 90 ml every 30 minutes
* Advance to low-calorie, full liquids
80
# Special Considerations Postoperative Care
Following bariatric surgery, patients find it challenging to maintain a prescribed diet. What should the nurse do?
Have patient reduce intake because of anatomic changes
Encourage patient to pay attention to nutrition is important to prevent early and/or late complications
81
# Special Considerations Postoperative Care
Why is long-term follow-up care is important for post bariatric surgery patients?
| Physical and psychologic reasons
* Old Diet Patterns: Patients may struggle with reverting to old, unhealthy eating habits.
* Issues Related to Return of Fertility in Women: Women may experience increased fertility after significant weight loss, requiring counseling on contraception.
* New Body Image: Patients may need support in adjusting to their new body image and the psychological changes associated with weight loss.
82
Which of the following are potential complications of persistent vomiting? Select all that apply.
A. Hypertension
B. Fluid volume deficit
C. Metabolic acidosis
D. Hypokalemia
E. Weight gain
F. Circulatory failure
B, D, F
Rationale:
* B: Vomiting leads to fluid loss, potentially causing dehydration.
* C: Loss of gastric acid can cause metabolic alkalosis, not acidosis.
* D: Vomiting can lead to potassium loss (hypokalemia).
* F: Severe fluid loss can impair circulation.
83
Which of the following are characteristic of chronic peptic ulcer disease (PUD)? Select all that apply.
A. Superficial erosion of the mucosa
B. Erosion through the muscular wall
C. Presence of fibrous tissue
D. More common than acute PUD
E. Continuous or intermittent symptoms
B, C, D, E
Rationale: Chronic PUD involves deeper erosion, fibrous tissue, is more prevalent, and has recurring symptoms.
84
A patient with persistent vomiting is at risk for which acid-base imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
D. Metabolic alkalosis
Rationale: Loss of gastric acid through vomiting leads to metabolic alkalosis.
85
A patient with a duodenal ulcer is experiencing sudden, severe abdominal pain. Which actions should the nurse take immediately? Select all that apply.
A. Administer prescribed pain medication.
B. Notify the healthcare provider.
C. Assess the patient's vital signs.
D. Place the patient in a supine position.
E. Prepare for possible surgery.
F. Encourage the patient to eat a bland diet.
A, B, C, E
Rationale: Sudden, severe pain may indicate perforation, requiring immediate medical attention and possible surgery.
86
Which of the following is a precancerous lesion that appears as red patches in the mouth?
A. Leukoplakia
B. Erythroplakia
C. Hyperkeratosis
D. Squamous cell carcinoma
B. Erythroplakia
Rationale: Erythroplakia is a precancerous lesion characterized by red patches or velvety areas in the mouth. It has a higher risk of progressing to oral cancer compared to leukoplakia (white patches).
87
Which of the following are potential signs and symptoms of shock in a patient with a massive upper gastrointestinal (UGI) bleed? Select all that apply.
A. Bradycardia
B. Hypotension
C. Cool extremities
D. Increased urine output
E. Prolonged capillary refill
F. Apprehension
B, C, E, F
Rationale:
* B. Hypotension: Blood loss leads to decreased blood volume, resulting in hypotension.
* C. Cool extremities: Reduced blood flow to the extremities causes them to become cool.
* E. Prolonged capillary refill: Capillary refill is delayed due to decreased peripheral perfusion.
* F. Apprehension: Anxiety and fear are common psychological responses to shock.
88
Which of the following nursing interventions are appropriate for a patient with a massive upper GI bleed in the acute care setting? Select all that apply.
A. Administering proton pump inhibitors (PPIs)
B. Monitoring urine output hourly
C. Administering large-bore IV fluids
D. Placing the patient in a high Fowler's position
E. Performing nasogastric (NG) lavage
F. Encouraging early ambulation
A, B, C, E
Rationale:
* A. Administering PPIs: PPIs reduce gastric acid secretion, promoting ulcer healing and reducing bleeding.
* B. Monitoring urine output hourly: Urine output reflects renal perfusion and overall hemodynamic status.
* C. Administering large-bore IV fluids: Rapid fluid replacement is essential to restore blood volume and prevent shock.
* E. Performing NG lavage: Lavage can remove blood and clots from the stomach, aiding in visualization during endoscopy and preventing nausea and vomiting.
89
Which laboratory finding is most indicative of significant blood loss in a patient with an upper GI bleed?
A. Elevated BUN
B. Increased liver enzymes
C. Decreased hemoglobin and hematocrit
D. Prolonged prothrombin time (PT)
C. Decreased hemoglobin and hematocrit
Rationale: Hemoglobin and hematocrit levels directly reflect the amount of circulating red blood cells. A decrease indicates blood loss.
90
A patient is receiving continuous enteral nutrition via a nasogastric tube. What is the recommended frequency for flushing the tube with warm water?
Every 4 hours
91
Which of the following are indications for parenteral nutrition (PN)? Select all that apply.
A. Mild nausea
B. Gastrointestinal obstruction
C. Severe anorexia nervosa
D. Chronic mild diarrhea
E. Complicated surgery or trauma
F. Short bowel syndrome
B, C, E, F
Rationale:
* B. Gastrointestinal obstruction: PN bypasses the GI tract, making it suitable when it's obstructed.
* C. Severe anorexia nervosa: PN provides nutrition when oral intake is severely inadequate.
* E. Complicated surgery or trauma: PN supports nutritional needs during periods of high stress and healing.
* F. Short bowel syndrome: PN is necessary when the small intestine is significantly shortened, impairing nutrient absorption.
92
Which of the following are criteria for bariatric surgery? Select all that apply.
A. BMI ≥ 30 kg/m²
B. BMI ≥ 40 kg/m²
C. BMI ≥ 35 kg/m² with at least one weight-related comorbidity
D. Hypertension
E. Type 1 diabetes
F. Sleep apnea
B, C, D, F
Rationale:
* B. BMI ≥ 40 kg/m²: This is a primary criterion for bariatric surgery.
* C. BMI ≥ 35 kg/m² with at least one weight-related comorbidity: This is another major criterion.
* D. Hypertension: A common comorbidity that qualifies a patient with a BMI ≥ 35 kg/m² for surgery.
* F. Sleep apnea: Another common comorbidity that qualifies a patient with a BMI ≥ 35 kg/m² for surgery.
93
Which of the following are important post-operative nursing interventions for a patient who has undergone gastric pacemaker implantation? Select all that apply.
A. Close observation for complications.
B. Encouraging early ambulation.
C. Monitoring for signs of re-sedation.
D. Providing a high-sugar diet.
E. Administering oxygen therapy as needed.
F. Discouraging deep breathing and coughing.
A, B, C, E
Rationale:
* A. Close observation for complications: Essential to identify and manage potential issues early.
* B. Encouraging early ambulation: Helps prevent complications like VTE and promotes recovery.
* C. Monitoring for signs of re-sedation: Important after anesthesia and pain medication administration.
* E. Administering oxygen therapy as needed: Supports respiratory function post-operatively.
94
Which of the following are components of post-operative care to prevent complications in patients who have undergone gastric pacemaker implantation? Select all that apply.
A. Stabilizing the airway.
B. Managing pain.
C. Keeping the head of the bed (HOB) elevated.
D. Administering a high-fat diet.
E. Implementing venous thromboembolism (VTE) precautions.
F. Discouraging the use of an incentive spirometer.
A, B, C, E
Rationale:
* A. Stabilizing the airway: Ensures proper oxygenation and ventilation.
* B. Managing pain: Promotes comfort and facilitates recovery.
* C. Keeping the HOB elevated: Helps prevent aspiration and improves respiratory function.
* E. Implementing VTE precautions: Reduces the risk of blood clots.
95
A nurse is teaching a patient about dietary changes after gastric pacemaker implantation. What should the nurse emphasize regarding the initial post-operative diet?
A. A high-protein, high-fat diet.
B. A low-sugar, clear liquid diet within 24 hours, advancing to low-calorie, full liquids.
C. A regular diet as tolerated.
D. A diet rich in complex carbohydrates.
B. A low-sugar, clear liquid diet within 24 hours, advancing to low-calorie, full liquids.
Rationale: This gradual progression helps the patient adapt to the anatomical changes and minimizes complications.
96
Which of the following are included in the pre-operative assessment for a patient undergoing gastric pacemaker implantation? Select all that apply.
A. Current use of assistive devices.
B. Past and current health information.
C. Coordination with specialists like cardiologists or pulmonologists.
D. Baseline blood glucose levels.
E. Dietary preferences.
F. Social support system.
A, B, C
Rationale:
* A. Current use of assistive devices: Important for planning post-operative care and mobility.
* B. Past and current health information: Essential to identify potential risks and complications.
* C. Coordination with specialists: Necessary for patients with co-morbidities that may increase surgical risks.
97
A patient who had a Roux-en-Y gastric bypass (RYGB) reports experiencing nausea, sweating, and weakness after eating a sugary dessert. What complication should the nurse suspect?
A. Gastric remnant distention
B. Ulcer formation
C. Dumping syndrome
D. Gallstone formation
C. Dumping syndrome
Rationale: Dumping syndrome occurs when gastric contents empty too rapidly into the small intestine, often triggered by sugary foods.
