The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse’s instruction?

"I will need to take vitamin B12 shots for the rest of my life.”

"I should avoid alcohol and tobacco of any type."

"I should eat small meals about six times a day."

"It is okay to continue to drink coffee in the morning when I get to work.’’

Answer and Explanation

The Correct Answer is B

Chronic gastritis involves prolonged inflammation of the gastric mucosa, which can lead to atrophy and intestinal metaplasia. Management focuses on eliminating mucosal irritants that compromise the protective bicarbonate-mucus barrier. Substances like ethanol and nicotine stimulate acid secretion and reduce mucosal blood flow, directly interfering with the stomach's ability to heal and increasing the risk of ulceration and malignancy.

Rationale:

A. While some forms of chronic gastritis (Type A) lead to pernicious anemia requiring vitamin B12 shots, this is a treatment for a specific complication, not a preventative measure for gastritis symptoms themselves. The goal of discharge teaching for general gastritis is to prevent the recurrence of inflammation and irritation, rather than managing long-term vitamin deficiencies.

B. Avoiding alcohol and tobacco is a fundamental instruction for preventing gastritis. Alcohol causes direct mucosal injury, and tobacco interferes with the secretion of protective bicarbonate and impairs the healing process. This statement shows the client understands how to remove the external factors that trigger inflammation and aggravate the gastric lining.

C. Eating small, frequent meals is a strategy often used for dumping syndrome or hiatal hernias, but it is not the primary intervention for preventing chronic gastritis. In fact, frequent eating can stimulate constant acid production, which may further irritate the stomach. The focus should be on the quality of the diet and the avoidance of known irritants.

D. Coffee, even decaffeinated, is a known gastric irritant that stimulates acid secretion. A client stating that it is okay to continue drinking coffee demonstrates a lack of understanding regarding dietary triggers. To prevent recurrent symptoms, the nurse should instruct the client to eliminate caffeine and other highly acidic or spicy beverages that exacerbate inflammation.

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Correct Answer is C

Explanation

A sickle cell crisis, specifically a vaso-occlusive crisis, occurs when deoxygenated hemoglobin S polymerizes, causing red blood cells to assume a rigid, crescent shape. These sickled cells obstruct microcirculation, leading to tissue ischemiaand infarction. This process triggers a massive inflammatory response and stimulates nociceptors, resulting in some of the most intense and debilitating pain managed in clinical medicine, requiring aggressive analgesic intervention.

Rationale:

A.Infection is a major concern for patients with SCD because of functional asplenia, which limits their ability to filter encapsulated bacteria. While infection can trigger a crisis, it is not the defining priority problem during the acute event itself. The nurse must monitor for sepsis, but the immediate physiological distress of the patient is driven by vaso-occlusionand the resulting systemic pain.

B.Pallor is an expected finding in sickle cell disease due to chronic hemolysis and the resulting anemia. While it reflects the low hemoglobin levels, it is a chronic adaptation rather than an acute priority during a crisis. Pallor does not indicate the severity of the ischemic insultas clearly as the patient's report of pain and the presence of localized tissue hypoxia.

C.Painis the highest priority problem during a sickle cell crisis. The mechanical obstruction of blood flow leads to severe tissue hypoxiaand ischemia in the bones, joints, and organs. Unrelieved pain can lead to increased stress, which further promotes sickling and worsens the crisis. Managing this pain is essential to break the cycle of ischemia and prevent permanent organ damage.

D.Fatigue is a persistent symptom for SCD patients due to their chronic hemolytic anemia and reduced oxygen-carrying capacity. During a crisis, fatigue may worsen, but it does not represent an immediate threat to the patient's stability. The intense nociceptive signalssent to the brain during a vaso-occlusive event make pain the urgent focus over the more generalized symptom of exhaustion.

A. Cream of potato soup, Caesar salad with chicken, and a diet cola B. Lasagna tossed salad with Italian dressing, and low-fat milk C. Roasted chicken breast, baked potato with chives, and orange juice D. Grilled cheese sandwich, tomato soup, and coffee with cream

Correct Answer is C

Explanation

Cholelithiasisinvolves the presence of gallstones within the gallbladder. Symptom management focuses on preventing gallbladder contraction, which occurs when cholecystokinin is released in response to the presence of fats in the duodenum. A diet low in saturated fatsis essential to minimize biliary colic and reduce the risk of stones becoming lodged in the cystic or common bile duct.

Rationale:

A.Cream of potato soup and Caesar salad are both high in fat content due to the heavy cream and oil-based dressings used in their preparation. These fats would trigger the release of cholecystokinin, leading to painful gallbladder contractions. This selection indicates a failure to understand the need to avoid high-fat triggers in the management of gallstones.

B.Lasagna is typically high in fat due to large amounts of cheese and ground meat. Italian dressing, while often oil-based, and lasagna together represent a significant fat load that would likely cause symptomatic distress. While low-fat milk is a better choice, the main course makes this menu selection inappropriate for someone with symptomatic cholelithiasis.

C.Roasted chicken breast (skinless) and a baked potato with chives represent a low-fat mealthat is least likely to stimulate the gallbladder. By avoiding butter, sour cream, and fried preparations, the patient minimizes the stimulus for bile release. This selection demonstrates a clear understanding of the dietary modifications required to prevent biliary colicepisodes.

D.A grilled cheese sandwich and coffee with cream are both high in animal fats and dairy lipids. Grilling bread in butter and using full-fat cheese are major triggers for gallbladder pain. This menu choice would likely lead to an acute episode of right upper quadrant pain, indicating that the patient does not yet understand the fat-restriction requirements.

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The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse’s instruction?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

The nurse is providing diet education to a client diagnosed with cholelithiasis. The goal is symptom management. Which menu selection indicates that the client understands the dietary teaching?

Correct Answer is C

Explanation

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