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A client is provided with materials to obtain three fecal occult blood tests (Hemoccult). What health teaching does the nurse provide? Select all that apply. A. "Avoid red meat and raw vegetables for a week before getting the samples." B. "Drink a gallon of Golightly before you collect the first sample." C. "Do not take food or fluids for 24 hours before the test." D. "Do not take ibuprofen for a week before obtaining the samples." E. "Avoid vitamin C tablets, foods, and juices a week before getting the samples." - The Answer: A, D, E Rationale: To avoid obtaining false-positive results associated with fecal occult blood tests (Hemoccult), patients must avoid certain foods before the test, such as raw fruits and vegetables and red meat. Vitamin C-rich foods, juices, and tablets must also be avoided. Anticoagulants, such as warfarin (Coumadin), and nonsteroidal anti-inflammatory drugs should be discontinued for 7 days before testing begins. What is a common gastrointestinal problem that older adults experience more frequently as they age?
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Decreased hydrochloric acid Excess lipase production Increased liver enzymes Increased peristalsis -The Atrophy of the gastric mucosa causes a decreased ratio of gastrin-secreting cells to somatostatin-secreting cells. This results in a decrease in hydrochloric acid, causing decreased absorption of iron and vitamin B12. In the pancreas, calcification of pancreatic vessels occurs, with a decrease in lipase production. The decrease in lipase results in decreased fat absorption and digestion. Steatorrhea and diarrhea can subsequently occur. The number and size of hepatic cells are decreased, which results in decreased enzyme activity; decreased liver enzyme activity depresses drug metabolism, and therefore may cause accumulation of drugs to toxic levels. In the large intestine, peristalsis is decreased and nerve impulses are dulled, which can result in postponement of bowel movements in older adults. A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal pain. Which assessment technique does the nurse use for this client? Assesses the abdomen in the following sequence: inspection, palpation, percussion, auscultation Examines the RUQ of the abdomen last
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Diarrhea -The These laboratory values are commonly found in clients with acute pancreatitis. They are not indicative of cirrhosis of the liver or Crohn's disease. These laboratory values are not found in a client with diarrhea. The nurse is assessing a client who has come to the emergency department with acute abdominal pain. The client is very thin and the nurse observes visible peristaltic movements when inspecting the abdomen. What does the nurse suspect? Acute diarrhea Aortic aneurysm Intestinal obstruction Pancreatitis -The Peristaltic movements are rarely seen except in thin clients and should be reported since the finding may indicate an intestinal obstruction. Acute diarrhea does not cause visible peristaltic movements. Aortic aneurysm may cause a bulging, pulsatile mass. Pancreatitis is characterized by severe pain. The nurse practitioner is performing an abdominal assessment on a newly admitted client. In which order should the nurse proceed with assessment technique? Auscultation, percussion, palpation, inspection Inspection, auscultation, percussion, palpation
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Palpation, percussion, inspection, auscultation Percussion, auscultation, palpation, inspection -The The abdomen is assessed by using the four techniques of examination, but in a sequence different from that used for other body systems: inspection, auscultation, percussion, and then palpation. This sequence is preferred so that palpation and percussion do not increase intestinal activity and bowel sounds. Nurse generalists may perform inspection, auscultation, and light palpation; percussion and deep palpation may be done by advanced practice nurses. A client with gastroesophageal reflux disease (GERD) is prescribed to start pantoprazole (Protonix) 40 mg every day. Which statement by the client requires further teaching by the nurse? A. "When I feel better, I can stop taking this drug." B. "I'll take this drug at 8 AM every morning." C. "This drug can cause headache and dizziness." D. "I should not crush the drug because it has a delayed release." - The Answer: A Rationale: Treatment for GERD should be continued even if a client begins to feel better. Discontinuation of therapy can result in return of original GERD symptoms, which can further damage esophageal tissues. Side effects of
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or with the use of two pillows. Chemicals used in processed foods, as well as smoking, can contribute to an increased risk for esophageal (and other types of) cancer. Excessive alcohol intake is associated with esophageal cancer. The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a client's hiatal hernia. Which change does the nurse recommend to this client? Eat only two or three meals daily. Sleep flat in a left side-lying position. Drink tea instead of coffee. Avoid working while bent over the computer. -The The client should avoid working while bent over because this position presses on the diaphragm, causing discomfort. The client with a hiatal hernia should eat four to six meals a day. The head of the client's bed should be elevated approximately 6 inches. Both tea and coffee should be eliminated from this client's diet because of the caffeine content. The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to a client diagnosed with esophageal cancer. Which instruction to the client is the highest priority? Place food at the back of the mouth as you eat.
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Do not be overly concerned with tongue or lip movements. Before swallowing, tilt the head back to straighten the esophagus. Do not attempt to reach food particles that are on the lips or around the mouth. -The Placing food at the back of the mouth when eating will help the client avoid aspirating. Both tongue movements and sealing of the lips should be monitored in this client. The client's head should be tilted forward in the chin-tuck position. The client should be able to reach food particles on her or his lips and around the mouth with the tongue. A client has undergone conventional esophageal surgery. The client's diet has been advanced to semi-solid, and feedings are well tolerated. The client reports experiencing diarrhea about 1 hour after each meal. What is the priority nursing intervention to help prevent further diarrhea? Ensure that the client takes adequate amounts of fluids with meals. Advance the diet to solid food and encourage eating as much as possible at meals. Give the client a dose of magnesium hydroxide (Milk of Magnesia) after each meal. Encourage the client to take fluids between meals rather than with meals. -The Diarrhea is believed to be the result
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chest and abdomen will be needed, but is not the nurse's initial action. A client in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? Teach the client about antacid effects and side effects. Ask the client about medications and dietary intake. Suggest that the client sleep with the head elevated 6 inches. Tell the client to avoid drinking alcohol late in the evening. -The The nurse's initial action should be further assessment of the client's risk factors for gastroesophageal reflux disease. Before suggesting interventions or beginning client teaching, the nurse must elicit more information about the client's symptoms. The nurse needs additional data before telling the client to avoid drinking alcohol late in the evening. The nurse is reviewing the medication history for a client diagnosed with gastroesophageal reflux disease who has been prescribed esomeprazole (Nexium) once daily. The client reports that the drug doesn't completely control the symptoms. The nurse contacts the provider to discuss which intervention? Adding a second proton pump inhibitor medication
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Increasing the dose of esomeprazole Changing to a twice-daily dosing regimen Switching to omeprazole (Prilosec) -The The proton pump inhibitors are usually effective when given once daily, but can be given twice daily if symptoms are not well controlled. Adding a second medication, increasing the dose, or switching to another proton pump inhibitor is not recommended. The nurse is caring for a client diagnosed with esophageal cancer who is experiencing diarrhea after conventional esophageal surgery. The nurse anticipates that the health care provider will request which medication to manage diarrhea? Loperamide (Imodium) Mesalamine (Pentasa) Minocycline (Minocin) Pantoprazole (Protonix) -The Diarrhea is thought to be the result of vagotomy syndrome, which develops as a result of interruption of vagal fibers to the abdominal viscera during surgery. It can occur 20 minutes to 2 hours after eating and can be symptomatically managed with loperamide. Mesalamine is used to treat clients with mild to moderate ulcerative colitis. Minocycline is an antibiotic used for treatment of infection. Pantoprazole is used to treat gastroesophageal reflux disease.
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D. A client who is NPO for tests to rule out gastric cancer - The Answer: C, B, A, D Rationale: A client with peptic ulcer disease experiencing a sudden onset of acute stomach pain is at risk for local gastric mucosal injury. Peptic ulcer perforation is a surgical emergency and can be life threatening; therefore, this client should be seen first. The client who had a gastrectomy is not expected to have moderate to severe pain 2 days after surgery and may be experiencing a complication. Therefore, this client should be assessed next. Although the client scheduled for an EGD and the client who is NPO are both scheduled for testing and do not require immediate attention, the client having an EGD needs to receive pretest care in preparation for this invasive procedure for which moderate sedation will be required. The last client to be assessed is the one who is not yet scheduled for testing at a specific time. When taking a history of a client diagnosed with a gastric ulcer, which assessment findings does the nurse expect? Select all that apply. A. Vomiting B. Weight loss C. Epigastric pain at night D. Relief of epigastric pain after eating
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E. Melena - The Answer: A, C, E Rationale: Clients with ulcer disease may experience nausea and vomiting, most commonly with pyloric sphincter dysfunction. Weight loss is most commonly associated with gastric cancer, not gastric ulcer. Duodenal ulcer pain occurs 90 minutes to 3 hours after eating and often awakens the client at night. However, eating does not lessen the pain; it actually is exacerbated (worsened) by certain foods and drugs. Minimal bleeding from ulcers is manifested by occult blood (melena). A client has undergone a subtotal (partial) gastrectomy for gastric cancer and is scheduled to begin radiation therapy. What is the most important information for the nurse to include in the teaching plan for this client? A. Management of alopecia B. Medication management C. Nutritional intake D. Skin care - The Answer: D Rationale: Although all of the choices should be part of the client's teaching plan, the priority is to ensure that the client has special skin care associated with external
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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? "It is okay to continue to drink coffee in the morning when I get to work." "I will need to take vitamin B12 shots for the rest of my life." "I should avoid alcohol and tobacco." "I should eat small meals about six times a day." -The The client with chronic gastritis should avoid alcohol and tobacco. The client should eliminate caffeine from the diet. The client will need to take vitamin B12 shots only if he or she has pernicious anemia. The client should not eat six small meals daily. This practice may actually stimulate gastric acid secretion. Which client assessment information is correlated with a diagnosis of chronic gastritis? Anorexia, nausea, and vomiting Frequent use of corticosteroids Hematemesis and anorexia Treatment with radiation therapy -The Treatment with radiation therapy is known to be associated with the development of chronic gastritis. Anorexia, nausea, and vomiting are all symptoms of acute gastritis.
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Corticosteroid use and hematemesis are also more likely to be signs of acute gastritis. The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which symptom is most significant in determining whether the client's ulceration is gastric or duodenal in origin? Pain occurs 1½ to 3 hours after a meal, usually at night. Pain is worsened by the ingestion of food. The client has a malnourished appearance. The client is a man older than 50 years. -The A key symptom of duodenal ulcers is that pain usually awakens the client between 1:00 a.m. and 2:00 a.m., occurring 1½ to 3 hours after a meal. Pain that is worsened with ingestion of food and a malnourished appearance are key features of gastric ulcers. A male over 50 years is a finding that could apply to either type of ulcer. The nurse is teaching a client with peptic ulcer disease about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? "Nizatidine (Axid) needs to be taken three times a day to be effective." "Taking ranitidine (Zantac) at bedtime should decrease acid production at night."
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Retape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. Document instructions for a client with chronic gastritis about how to use "triple therapy." Assess the gag reflex for a client who has arrived from the postanesthesia care unit after a laparoscopic gastrectomy. -The Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN. Retaping the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy is a complex task that should be done by the RN. Assessment and documenting instructions about how to use triple therapy are nursing functions that should be done by the RN. The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? Apply antiembolism stockings. Place a nasogastric (NG) tube, and connect to suction. Insert an indwelling catheter, and check output hourly. Give famotidine (Pepcid) 20 mg IV every 12 hours. -The To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. Antiembolism
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stockings will need to be applied, monitoring output is important, and famotidine (Pepcid) will need to be administered, but the nurse's first priority is to minimize the risk for peritonitis. The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? Bismuth subsalicylate (Pepto-Bismol) Magnesium hydroxide (Maalox) Metronidazole (Flagyl) Misoprostol (Cytotec) -The Misoprostol is a prostaglandin analogue that protects against nonsteroidal anti- inflammatory drug (NSAID)-induced ulcers. Bismuth subsalicylate is an antidiarrheal drug that contains salicylates, which can cause bleeding and should be avoided in clients who have PUD. Magnesium hydroxide is an antacid that may be used to neutralize stomach secretions, but is not used specifically to help prevent NSAID-induced ulcers. Metronidazole is an antimicrobial agent used to treat Helicobacter pylori infection. A nurse is caring for a client following a laparoscopic hernia repair surgery. Which assessment finding will the nurse report to the surgeon immediately?
