a
26. A client has experienced symptoms of dumping syndrome following gastric surgery. To what physiologic phenomenon does the nurse attribute this syndrome?
A. Irritation of the phrenic nerve due to diaphragmatic pressure B. Chronic malabsorption of iron and vitamins A and C
C. Reflux of bile into the distal esophagus
D. Influx of extracellular fluid into the small intestine
ANS: D
Rationale: The rapid bolus of hypertonic food from the stomach to the small intestines draws extracellular fluid into the lumen of the intestines to dilute the high concentrations of electrolytes and sugars, which results in intestinal dilation, increased intestinal transit, hyperglycemia, and the rapid onset of GI and vasomotor symptoms, which characterizes dumping syndrome. It is not a result of phrenic nerve irritation, malabsorption, or bile reflux.
35. A client with gastric cancer has been scheduled for a total gastrectomy. During the preoperative assessment, the client confides in the nurse feeling the surgery will "mutilate" the client’s body. The nurse should plan interventions that address what nursing diagnosis?
A. Disturbed body image
B. Deficient knowledge related to the risks of surgery
C. Anxiety about the surgery
D. Low self-esteem
ANS: A
Rationale: The client's choice of words ("mutilate") suggests a change in body image. This may or may not be rooted in anxiety or a lack of knowledge. It may cause an eventual reduction in self-esteem but the essence of the statement is the client's body image.
27. The nurse is providing care for a client who has recently been diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease?
A. Performing 15 minutes of physical activity at least three times per week
B. Avoiding taking aspirin to treat pain or fever
C. Taking multivitamins as prescribed and eating organic foods whenever possible
D. Maintaining a healthy body weight
ANS: B
Rationale: Aspirin and other NSAIDs are implicated in chronic gastritis because of their irritating effect on the gastric mucosa. Organic foods and vitamins confer no protection. Exercise and a healthy body weight are beneficial to overall health but do not prevent gastritis.
34. A client has come to the clinic reporting pain just above her umbilicus. When assessing the client, the nurse notes Sister Mary Joseph nodules. The nurse should refer the client to the primary provider to be assessed for what health problem?
A. A GI malignancy
B. Dumping syndrome
C. Peptic ulcer disease
D. Esophageal/gastric obstruction
ANS: A
Rationale: Palpable nodules around the umbilicus, called Sister Mary Joseph nodules, are a sign of a GI malignancy, usually a gastric cancer. This would not be a sign of dumping syndrome, peptic ulcer disease, or esophageal/gastric obstruction.
28. A client has just been diagnosed with acute gastritis after presenting in distress to the emergency department with abdominal symptoms. Which of the following actions should the nurse prioritize?
A. Teaching the client about necessary nutritional modification
B. Helping the client weigh treatment options
C. Teaching the client about the etiology of gastritis
D. Providing the client with physical and emotional support
ANS: D
Rationale: For acute gastritis, the nurse provides physical and emotional support and helps the client manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The scenario describes a newly diagnosed client; teaching about the etiology of the disease, lifestyle modifications, or various treatment options would be best provided at a later time.
33. The nurse is providing care for a client whose peptic ulcer disease will be treated with a Billroth I procedure (gastroduodenostomy). Which statement(s) by the client indicates effective knowledge of the procedure? Select all that apply.
A. “I will be at risk of developing diarrhea, nausea, and feeling light-headed after
eating.”
B. “It is likely that I will need to receive nutrition directly into my veins.”
C. “One of my nerves, the vagus nerve, may be cut during the surgery.”
D. “I can eat a normal diet again after 3 to 5 weeks.”
E. “This surgery will remove part of my stomach and colon.”
ANS: A, C
Rationale: This surgery carries a risk for dumping syndrome and may be performed with a truncal vagotomy, in which the vagus nerve is severed. Dumping syndrome is a condition in which food empties rapidly from the stomach to the duodenum, resulting in diarrhea, nausea, and feeling light-headed after eating a meal. Parenteral nutrition is not expected, though life-long dietary modifications will be necessary. A portion of the duodenum is removed, but not the colon.
29. A client is undergoing diagnostic testing for a tumor of the small intestine. What are the most likely symptoms that prompted the client to first seek care?
A. Hematemesis and persistent sensation of fullness
B. Abdominal bloating and recurrent constipation
C. Intermittent pain and bloody stool
D. Unexplained bowel incontinence and fatty stools
ANS: C
Rationale: When the client is symptomatic from a tumor of the small intestine, benign tumors often present with intermittent pain. The next most common presentation is occult bleeding. The other listed signs and symptoms are not normally associated with the presentation of small intestinal tumors.
32. An adult client with a history of dyspepsia has been diagnosed with chronic gastritis. The nurse's health education should include what guidelines? Select all that apply.
A. Avoid drinking alcohol
B. Adopt a low-residue diet
C. Avoid nonsteroidal anti-inflammatories
D. Take calcium gluconate as prescribed E. Prepare for the possibility of surgery
ANS: A, C
Rationale: Clients with chronic gastritis are encouraged to avoid alcohol and NSAIDs. Calcium gluconate is not a common treatment and the condition is not normally treated with surgery. Dietary modifications are usually recommended, but this does not necessitate a low-residue diet.
30. A client with a history of peptic ulcer disease has presented to the emergency department (ED) in distress. What assessment finding would lead the ED nurse to suspect that the client has a perforated ulcer?
A. The client has abdominal bloating that developed rapidly.
B. The client has a rigid, "board-like" abdomen that is tender.
C. The client is experiencing intense lower right quadrant pain.
D. The client is experiencing dizziness and confusion with no apparent hemodynamic changes.
ANS: B
Rationale: An extremely tender and rigid (board-like) abdomen is suggestive of a perforated ulcer. None of the other listed signs and symptoms is suggestive of a perforated ulcer.
31. Diagnostic testing of a client with a history of dyspepsia and abdominal pain has resulted in a diagnosis of gastric cancer. The nurse's anticipatory guidance should include what information?
A. The possibility of surgery, chemotherapy and radiotherapy
B. The possibility of needing a short-term or long-term colostomy
C. The benefits of weight loss and exercise as tolerated during recovery
D. The good prognosis for clients who are treated for gastric cancer
ANS: A
Rationale: Treatment of gastric cancer is usually multimodal, but does not necessitate a colostomy. Weight loss is not a goal during recovery; exercise is not a high priority and may be unrealistic. The prognosis for clients with gastric cancer is generally poor.