- The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client’s abdomen is tense and rigid. What action takes priority?
a. Administer the prescribed pain medication.
b. Notify the health care provider immediately.
c. Percuss all four abdominal quadrants.
d. Take and document a set of vital signs.
ANS: B
This client has manifestations of a perforated ulcer, which is an emergency. The priority is to get the client med- ical attention. The nurse can take a set of vital signs while someone else calls the provider. The nurse should not percuss the abdomen or give pain medication since the client may need to sign consent for surgery.
- A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes prior- ity?
a. Document the ndings in the chart.
b. Request an electrocardiogram (ECG).
c. Facilitate a serum potassium test.
d. Place the client on bedrest.
ANS: B
Pyloric stenosis can lead to hypokalemia, which is manifested by muscle weakness. The nurse rst obtains an ECG because potassium imbalances can lead to cardiac dysrhythmias. A potassium level is also warranted, as is placing the client on bedrest for safety. Documentation should be thorough, but none of these actions takes priority over the ECG.
- A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client’s blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate?
a. Administer ibuprofen (Motrin).
b. Call the Rapid Response Team.
c. Start a large-bore IV with normal saline.
d. Tell the client to remain lying down.
ANS: C
This client has orthostatic changes to the blood pressure, indicating uid volume loss. The nurse should start a large-bore IV with isotonic solution. Ibuprofen will exacerbate the ulcer. The Rapid Response Team is not need- ed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the priority.
- A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most ap- propriate?
a. Assess the client for iodine or shell sh allergies.
b. Educate the client on the side e ects of sedation.
c. Inform the client a second scan may be needed.
d. Teach the client about bowel preparation for the scan.
ANS: C
A second scan may be performed in 1 to 2 days to see if interventions have worked. The nuclear medicine scan does not use iodine-containing contrast dye or sedation. There is no required bowel preparation.
- A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important?
a. Alcohol intake of 1 to 2 drinks per week
b. Family history of H. pylori infection
c. Former smoker still using nicotine patches d. Willingness to adhere to drug therapy
ANS: D
Treatment for this infection involves either triple or quadruple drug therapy, which may make it di cult for clients to remain adherent. The nurse should assess the client’s willingness and ability to follow the regimen. The other assessment ndings are not as critical.
- An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client?
a. Check with the pharmacist before taking other medications.
b. Increase intake of calcium and vitamin D.
c. Report any worsening of symptoms to the provider.
d. Take the medication as prescribed by the provider.
ANS: B
All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any medication and are not specic to the use of esomeprazole.
- The nurse caring for clients with gastrointestinal disorders should understand that which category best de- scribes the mechanism of action of sucralfate (Carafate)?
a. Gastric acid inhibitor
b. Histamine receptor blocker
c. Mucosal barrier forti er
d. Proton pump inhibitor
ANS: C
Sucralfate is a mucosal barrier fortier (protector). It is not a gastric acid inhibitor, a histamine receptor blocker, or a proton pump inhibitor.
- A nurse answers a client’s call light and nds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first?
a. Assist the client back to bed.
b. Notify the provider immediately.
c. Put on a pair of gloves.
d. Take a set of vital signs.
ANS: C
All of the actions are appropriate; however, the nurse should put on a pair of gloves rst to avoid contamina- tion with blood or body uids.
- A client had an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort mea- sure may the nurse delegate to the unlicensed assistive personnel (UAP)?
a. Lavaging the tube with ice water
b. Performing frequent oral care
c. Re-positioning the tube every 4 hours
d. Taking and recording vital signs
ANS: B
Clients with NG tubes need frequent oral care both for comfort and to prevent infection. Lavaging the tube is done by the nurse. Re-positioning the tube, if needed, is also done by the nurse. The UAP can take vital signs, but this is not a comfort measure.
- A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should the nurse report to the surgeon immediately?
a. Albumin: 2.1 g/dL
b. Hematocrit: 28%
c. Hemoglobin: 8.1 mg/dL
d. International normalized ratio (INR): 4.2
ANS: D
An INR as high as 4.2 poses a serious risk of bleeding during the operation and should be reported. The albu- min is low and is an expected nding. The hematocrit and hemoglobin are also low, but this is expected in gas- tric cancer.
- A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate?
a. “Do you have family or friends for support?”
b. “I’d like to know what you are feeling now.”
c. “Well, we knew this would probably happen.”
d. “Would you like me to refer you to hospice?”
ANS: B
The nurse assesses the client’s emotional state with open-ended questions and statements and shows a willing- ness to listen to the client’s concerns. Asking about support people is very limited in nature, and “yes-or-no” questions are not therapeutic. Stating that this was expected dismisses the client’s concerns. The client may or may not be ready to hear about hospice, and this is another limited, yes-or-no question.
- A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best?
a. “Slippery elm has no bene t for this problem.”
b. “Slippery elm is often used for this disorder.”
c. “There is no evidence that this will work.”
d. “You should not take any herbal remedies.”
ANS: B
There are several complementary and alternative medicine regimens that are used for gastritis and peptic ulcer disease. Most have been tested on animals but not humans. Slippery elm is a common supplement used for this disorder.
- A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruc- tion is most appropriate?
a. “Aspirin must be avoided.”
b. “Do not worry about black stools.”
c. “Report diarrhea to your provider.”
d. “Take 1 hour before meals.”
ANS: C
Maalox can cause hypermagnesemia, which causes diarrhea, so the client should be taught to report this to the provider. Aspirin is avoided with bismuth sulfate (Pepto-Bismol). Black stools can be caused by Pepto-Bismol. Maalox should be taken after meals.
- For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)? a. Client taking antacids
b. Client taking antibiotics
c. Client who is pregnant
d. Client over 65 years of age
ANS: C
Misoprostol can cause abortion, so pregnant women should not take this drug. The other clients have no con- traindications to taking misoprostol.
- A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most help- ful?
a. Arrange a dietary consult.
b. Increase uid intake.
c. Limit the client’s foods.
d. Make the client NPO.
ANS: A
The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian will be extremely helpful. Food and uid intake is complicated and needs planning. The client should not be NPO.
- An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client told about her diagnosis. What action by the nurse is best?
a. Ask the family why they feel this way.
b. Assess family concerns and fears.
c. Refuse to go along with the family’s wishes.
d. Tell the family that such secrets cannot be kept.
ANS: B
The nurse should use open-ended questions and statements to fully assess the family’s concerns and fears. Asking “why” questions often puts people on the defensive and is considered a barrier to therapeutic communi- cation. Refusing to follow the family’s wishes or keep their con dence will not help move this family from their position and will set up an adversarial relationship.
- The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following? (Select all that apply.)
a. Alcohol
b. Ca eine
c. Corticosteroids
d. Fruit juice
e. Nonsteroidal anti-in ammatory drugs (NSAIDs)
ANS: A, B, C, E
Risk factors for acute gastritis include alcohol, caeine, corticosteroids, and chronic NSAID use. Fruit juice is not a risk factor, although in some people it does cause distress.
- A client has a gastrointestinal hemorrhage and is prescribed two units of packed red blood cells. What ac- tions should the nurse perform prior to hanging the blood? (Select all that apply.)
a. Ask a second nurse to double-check the blood.
b. Prime the IV tubing with normal saline.
c. Prime the IV tubing with dextrose in water.
d. Take and record a set of vital signs.
e. Teach the client about reaction manifestations.
ANS: A, B, D, E
Prior to starting a blood transfusion, the nurse asks another nurse to double-check the blood (and client identi- ty), primes the IV tubing with normal saline, takes and records a baseline set of vital signs, and teaches the client about manifestations to report. The IV tubing is not primed with dextrose in water.
- The student nurse learns about risk factors for gastric cancer. Which factors does this include? (Select all that apply.)
a. Achlorhydria
b. Chronic atrophic gastritis
c. Helicobacter pylori infection d. Iron de ciency anemia
e. Pernicious anemia
ANS: A, B, C, E
Achlorhydria, chronic atrophic gastritis, H. pylori infection, and pernicious anemia are all risk factors for devel- oping gastric cancer. Iron deciency anemia is not a risk factor.
- A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.)
a. Canned unsweetened apricots
b. Co ee cake
c. Milk shake
d. Potato soup
e. Steamed broccoli
ANS: A, D
Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, low- to moderate-carbohydrate diet. Coee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.
- A nurse working with a client who has possible gastritis assesses the client’s gastrointestinal system. Which ndings indicate a chronic condition as opposed to acute gastritis? (Select all that apply.)
a. Anorexia
b. Dyspepsia
c. Intolerance of fatty foods d. Pernicious anemia
e. Nausea and vomiting
ANS: C, D
Intolerance of fatty or spicy foods and pernicious anemia are signs of chronic gastritis. Anorexia and nausea/vomiting can be seen in both conditions. Dyspepsia is seen in acute gastritis.
- A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to promote better nutrition? (Select all that apply.)
a. Administer vitamin B12 injections.
b. Ask the provider about folic acid replacement.
c. Educate the client on enteral feedings.
d. Obtain consent for total parenteral nutrition.
e. Provide iron supplements for the client.
ANS: A, B, E
After gastrectomy, clients are at high risk for anemia due to vitamin B12 deciency, folic acid deciency, or iron deciency. The nurse should provide supplements for all these nutrients. The client does not need enteral feed- ing or total parenteral nutrition.
- A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate? (Select all that apply.)
a. Administer the drug through a separate IV line.
b. Infuse pantoprazole using an IV pump.
c. Keep the drug in its original brown bag.
d. Take vital signs frequently during infusion.
e. Use an in-line IV lter when infusing.
ANS: A, B, E
When infusing pantoprazole, use a separate IV line, a pump, and an in-line lter. A brown wrapper and frequent vital signs are not needed.
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Chapter 333
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Chapter 5419
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Chapter 5523
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Chapter 5629
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Chapter 5729
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Chapter 5825
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Chapter 5925
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PRACTICE50
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Alzheimers Disease3
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Parkinsons disease27
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lewis: hedache seizures26
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Chapter 44: iggy22
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Chapter 66; Brunner headache seizures17
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Resource 166
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Select all15
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Eye review78
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Final Review- Eye/Ear54
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Final Review- Blood16
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Final Review- Old stuff42
