Chapter 28: Care of Patients with Disorders of the Upper Gastrointestinal System |deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition

MULTIPLE CHOICE 1. The nurse explains that the diagnosis of morbidly obese is reserved for people who exceed which percentage of their recommended weight? a. 50% b. 70% c. 90% d. 100% ANS: D Those people who weigh 100% over their recommended weight are considered morbidly obese. PTS:1 DIF: Cognitive Level: Comprehension REF: 645 OBJ:1 TOP: Obesity: Morbid Obesity KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. The nurse calculates the body mass index (BMI) of a man who is 6 feet tall and weighs 150 pounds. Which value is correct? a. 21.0 b. 25.0 c. 43.1 d. 66.3 ANS: A The formula to calculate BMI is: weight in kilograms divided by height in meters squared (68.1 kilograms ÷ 3.24 meters = 21.0). PTS:1 DIF: Cognitive Level: Application REF: 645 OBJ:1 TOP: BMI: Calculation KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. The nurse explains that the laparoscopic adjustable gastric banding surgery is best described as which type of bariatric surgery? a. Restrictive b. Malabsorptive c. Restrictive/malabsorptive d. Obstructive ANS: A The three types of bariatric surgery are restrictive, malabsorptive, and restrictive/malabsorptive. Laparoscopic adjustable gastric banding is performed by placing an inflatable band around the fundus of the stomach and is considered restrictive. This procedure may be performed laparoscopically. The band is inflated and deflated via a subcutaneous port to change the size of the stomach as the patient loses weight. PTS:1 DIF: Cognitive Level: Comprehension REF: 646 OBJ:1 TOP: Restrictive Procedures KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. The nurse is discussing bariatric surgery complications with a patient. Which statement indicates that the patient accurately understands the nurse’s teaching about common procedural side effects? a. “I understand that gastric ulcers frequently occur in patients who have bariatric surgery.” b. “Gallstones are a common occurrence in patients who have bariatric surgery.” c. “I know an umbilical hernia might happen after I have bariatric surgery.” d. “Unfortunately, I may experience gastritis after having bariatric surgery.” ANS: B Nutritional deficiencies caused by the banding result in the formation of gallstones in a large percentage of bariatric surgery patients. About a third of patients who undergo bariatric surgery develop gallstones. PTS: 1 DIF: Cognitive Level: Comprehension REF: 646 OBJ: 1 TOP: Bariatric Surgery: Side Effects KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse is caring for a patient with suspected dysphagia. Which action is most appropriate for the nurse to take? a. Encourage incentive spirometry use. b. Instruct the patient to take practice swallows before the meal. c. Encourage patient attempts to communicate, and pay attention to nonverbal cues. d. Encourage the patient to keep a food diary. ANS: B Dysphagia means difficulty in swallowing. The nurse should have the patient take some “practice swallows” before beginning the meal, and watch to see that the larynx rises with each swallow. Incentive spirometry usage is important or patients with dyspnea, or shortness of breath. Encouraging communication and paying attention to nonverbal cues is an effective intervention for aphasia (inability to use or understand words). Keeping a food diary may be useful in cases of polyphagia (extreme hunger), but it does not evaluate whether or not the patient can swallow effectively. PTS:1 DIF: Cognitive Level: Application REF: 648 OBJ:6 TOP: Dysphagia: Evaluation of the Swallow KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 6. A patient with a gastrostomy tube gets a bolus feeding of 200 mL every 4 hours. Before giving the bolus, the nurse aspirates a residual of 100 mL. Which action is most appropriate?