HOGAN ch 59
A client states, "My doctor told me to quit taking aspirin since I've developed this ulcer. I have to take aspirin to keep my arthritis from hurting. I don't know what to do." Which response on the part of the nurse is best?
"Aspirin is one of the medications that makes an ulcer worse; another medicine can be ordered by the doctor for your arthritis."
A client with a subtotal gastrectomy is scheduled for discharge. Which instruction should the nurse give the client to reduce the possibility of dumping syndrome?
"Avoid drinking fluids with your meal."
A client is to have an intestinal tube placed to decompress the bowel. What instruction should the nurse provide to the client?
"Avoid pulling or tugging on the tube."
A client says to the nurse, "My doctor told me my ulcer may have been caused by bacteria. I thought ulcers were caused by diet and too much stress." Which response by the nurse is the best?
"Even though the bacteria Helicobacter pylori causes inflammation, other factors may cause increased acid in the stomach."
A client diagnosed with peptic ulcer disease wants to know why antibiotics are being administered. What is the nurse's best response?
"H. pylori is a bacterial cause for PUD and antibiotics will treat the cause."
The nurse teaches the client with gastroesophageal reflux disease (GERD) about ways to minimize symptoms. Which statement made by the client indicates that more teaching is needed?
"I will be sure to drink tea instead of coffee."
The nurse is preparing a client with a hiatal hernia for discharge. Which statement made by the client would indicate that teaching has been effective?
"I will take a walk after dinner each night."
The nurse discusses a home maintenance regimen with a client being treated for irritable bowel syndrome. Which statement indicates client understanding?
"I'll take an early-evening walk each day after work."
A client with a history of peptic ulcer disease taking ranitidine (Zantac) questions the action of this drug. What is the best response by the nurse?
"It blocks the secretion of hydrochloric (HCl) acid in the stomach."
An older adult client expresses concern about the possibility of constipation, stating "I have not had a bowel movement today at all, and I don't want to get an obstruction. I would like to take a laxative" Which response by the nurse is most helpful to the client?
"It is better to control your bowel habits with increased fiber and increased fluid intake."
The mother of a child undergoing an emergency appendectomy tells the nurse, "If I had brought him in yesterday when he complained of an upset stomach, this wouldn't have happened." What is the best response by the nurse?
"It is often difficult to predict when a simple complaint will become more serious."
A client asks, "What conditions lead to the development of gallstones? My mother had a bad time with them and I want to avoid them if I can." Which response is the best by the nurse?
"Overweight middle-aged women are especially susceptible."
The client who has acute cholecystitis tells the nurse, "I just want my gallbladder taken out now." What is the best response by the nurse?
"The symptoms are distressing, but the surgeon must wait until your gallbladder is less infected."
A client says to the nurse "I have this pain from my ulcer. When it comes on at night, I have difficulty sleeping." Which would be the nurse's best response?
"Try limiting the volume of food you eat at bedtime."
The post-cholecystectomy client asks the nurse when the T-tube will be removed. Which response by the nurse would be appropriate?
"When your stool returns to a normal brown color the tube can be removed."
The post-cholecystectomy client asks the nurse when the T-tube will be removed. Which response by the nurse would be appropriate?
"When your stool returns to a normal brown color, the tube can be removed."
In scheduling a twice daily dose of antacid for a client with a hiatal hernia who is receiving other medications at 8:00 A.M. and 8:00 P.M., the nurse plans to schedule the antacid at which earliest time?
10:00 A.M. and 10:00 P.M.
Prior to giving an analgesic for pain to a postoperative client who has a history of peptic ulcer disease (PUD), the nurse should check to see that the agent does not contain which of the following?
Acetylsalicylic acid (aspirin)
The nurse caring for a client with uncomplicated cholelithiasis anticipates that the client's laboratory results will show an elevation in which test?
Alkaline phosphatase
The nurse caring for a client with uncomplicated cholelithiasis should expect an elevation in which laboratory test?
Alkaline phosphatase
Decreased excretion of bilirubin would probably be attributed to which problem?
An obstructed common bile duct
The nurse determines that which client would be most at risk for an intestinal obstruction?
An older adult who is on bed rest because of postoperative abdominal surgery
A 9-year-old male client with severe esophagitis is 12 hours status/post-Nissen fundoplication for gastroesophageal reflux. What action by the nurse would be appropriate while providing nursing care?
Ask him to choose a face on the Wong FACES pain rating scale.
A 9-year-old with severe esophagitis is 12 hours status/post-Nissen fundoplication for gastroesophageal reflux (GER). To implement appropriate nursing care, what should the nurse should include in the plan of care?
Ask him to rank his pain on a scale of zero to 10 when zero is no pain and 10 is the worst possible pain
In caring for a client 4 days post-cholecystectomy, the nurse notices that drainage from the T-tube is 600 mL in 24 hours. Which is the most appropriate action by the nurse?
Assess drainage characteristics and notify the healthcare provider
The nurse should provide which instruction to a client being treated for chronic cholecystitis?
Avoid sausage, bacon, fried foods, and peanut butter
The nurse at a health fair at a local senior center explains that diverticular disease is most likely to occur in older adults for which reason?
Blood supply and diet.
A client with diverticular disease undergoes a colonoscopy. The nurse should assess the client for which possible complication of the procedure?
Bowel perforation
The nurse should question the client with gastroesophageal reflux disease (GERD) about the use of which medication that decreases lower esophageal sphincter (LES) pressure?
Calcium channel blockers
The client with cholelithiasis is scheduled for extracorporeal shock wave lithotripsy. The nurse should tell the client about which symptoms that may occur after this procedure?
Colic-type pain
A client who had been admitted for shock develops symptoms of peptic ulcer disease several days later. The nurse concludes that this most likely developed for which reason?
Decreased mucus production.
An elderly male client is worried about bright red blood in his stool along with feeling tired and worn out. The nurse determines that these symptoms are characteristic of:
Descending (left-sided) colon cancer.
A client who had Billroth I surgery is beginning to eat solid foods. The nurse assesses the client for which sign that would be indicative of dumping syndrome?
Diarrhea
A client with suspected duodenal ulcer has an upper GI series with meglumine diatrizoate (Gastrografin). The nurse should inform the client about which side effect of this contrast medium?
Diarrhea
An older adult client presents with fever, leukocytosis, left lower quadrant pain, and diarrhea alternating with constipation. The nurse concludes that these are frequently seen in clients with:
Diverticulitis.
When teaching preventive measures to a client who has a strong family history for cholelithiasis, which guideline is most important?
Eat a low-fat, low-cholesterol diet
When admitting a client to the hospital with suspected acute cholecystitis, which laboratory test would help the nurse to know if liver damage is present?
Elevated direct bilirubin
A client is being evaluated for possible duodenal ulcer. The nurse assesses the client for which manifestation that would support this diagnosis?
Epigastric pain relieved by food
The nurse would expect which assessment finding in a client with duodenal ulcers?
Epigastric pain relieved by food
A female client recently diagnosed with a duodenal ulcer suddenly experiences severe abdominal pain, increased heart rate, increased respiratory rate, and diaphoresis. On palpation, the abdomen is rigid; bowel sounds are faint and diminished. Which action by the nurse is appropriate?
Establish IV access and report assessment data to the physician.
A 7-year-old boy is admitted to the hospital because of frequent bouts of burning pain in the middle of his chest and frequent regurgitation. A pH probe test is done and reveals over 100 drops in the pH to between 2.0 and 3.5 within a 24-hour period; however, none of the decreases remained low for longer than 2 to 3 seconds. The nurse suspects that the child most likely has which disorder?
Gastroesophageal reflux disease (GERD)
A clientreports dyspepsia, frequent belching, and increased salivation. The nurse suspects which of the following?
Gastroesophageal reflux disease (GERD)
A client with diverticular disease undergoes a colonoscopy. During an abdominal assessment, the nurse looks for which sign to indicate a possible complication of the procedure?
Guarding and rebound tenderness
A client is admitted to the hospital with a bowel obstruction. Which finding by the nurse would indicate that the obstruction is in the early stages?
High-pitched, tinkling bowel sounds
A 3-month-old infant has gastroesophageal reflux disease (GERD) but is thriving without other complications. The mother wants to know what to do differently to decrease the reflux. Which intervention should the nurse suggest to minimize reflux?
Increase frequency of feedings and keep them small.
A client is admitted with a large, distended rigid bowel, acute tenderness with abdominal palpation, fever, and absent bowel sounds. During the next day, the client's level of consciousness decreases, and begins to have feculent vomit. The nurse concludes that which priority therapeutic intervention should be ordered?
Insertion of a nasogastric tube for gastric decompression
A client is taking misoprostol (Cytotec) because of an ulcer that developed while taking NSAIDs for arthritis. The client questions the action of the drug. Which is the most appropriate explanation?
It promotes healing by promoting mucus production and bicarbonate secretions.
A client was admitted to the hospital with cholelithiasis the previous day. Which new assessment finding indicates to the nurse that the stone has probably obstructed the common bile duct?
Jaundice
The client has cholelithiasis. Which assessment finding indicates to the nurse that the stone has probably obstructed the common bile duct?
Jaundice
Which comfort measure would be appropriate for the nurse to implement for a client with jaundice?
Keep the air temperature at approximately 68 to 70 degrees F
An older adult male presents to the outpatient clinic reporting changes in bowel habits, increased diarrhea, thin stools, and some rectal bleeding. The nurse would be most concerned about which of the following?
Left-sided colorectal cancer.
The client with a duodenal ulcer asks the nurse why an antibiotic is part of the treatment regimen. Which information should the nurse include in the response?
Many duodenal ulcers are caused by the Helicobacter pylori organism.
The nurse is caring for a child with a history of severe diarrhea. Which acid-base abnormality would the nurse assess for in arterial blood gas results as a possible consequence of the diarrhea?
Metabolic acidosis
The nurse is caring for a child with a history of severe diarrhea. Which notation about acid-base imbalance would the nurse expect to find in the medical record?
Metabolic acidosis
While recovering from a burn, a client suddenly begins to vomit blood, but denies any pain. The nurse concludes this is characteristic of which manifestation?
Multiple superficial ulcers that occur following a major trauma.
Which client would the nurse consider to be at high risk for a functional paralytic intestinal obstruction?
One who develops a paralytic ileus after abdominal surgery.
The nurse is developing a health promotion program for intestinal health. Which item of information should the nurse include in the program?
The addition of dietary fiber can reduce the risk of diverticulosis.
The client with gastroesophageal reflux disease (GERD) is prescribed famotidine (Pepcid). In order to provide effective teaching, the nurse must have which understanding about the action of the drug?
The drug decreases the secretion of gastric acid.
A female client hospitalized for a broken pelvis from a motor vehicle accident is being sent home on an H2-antagonist and an antacid as part of her home medications. When the client questions why, what explanation should the nurse give?
The medications are a preventive measure only.
A client is being admitted to a hospital unit reporting severe pain in the lower abdomen and is lying on the bed with his knees flexed. Admission vital signs reveal an oral temperature of 101.2 degrees F. Which of the following would confirm a diagnosis of appendicitis?
The pain is localized at a position halfway between the umbilicus and the right iliac crest.
A child with a confirmed diagnosis of appendicitis has been scheduled for an emergency appendectomy. Suddenly, the child states his pain is much less. What is the best interpretation of this change?
There is a possibility the appendix has ruptured.
A female client reports a burning, cramping pain in the top part of the abdomen that becomes worse in the middle of the afternoon and sometimes awakens her at night. She reports that eating something usually helps the pain go away but that the pain is now becoming more intense. What is the best conclusion for the nurse to draw?
These symptoms are consistent with an ulcer.
A client is admitted with cholelithiasis. The nurse anticipates that which most common test will be ordered to diagnose this disease?
Ultrasound (US) of gallbladder
The client is admitted to the hospital for possible cholelithiasis. While taking the history, the nurse notes that the client has which risk factor for the development of gallstones?
Use of oral contraceptives
A client has undergone a total gastrectomy. The nurse should teach the client about long-term treatment for which of these conditions?
Vitamin B12 deficiency
Which client symptom would lead the nurse to suspect that a client has peritonitis?
abdominal rigidity
A client visiting an outpatient clinic mentions that she has been having severe indigestion and burning in her chest. The nurse takes a history and learns that she does not smoke or consume alcohol. What would be another dietary consideration to ask about initially?
amount of caffeine
A 14-year-old boy is brought into the emergency department with a diagnosis of rule out appendicitis. He states he is having right lower quadrant pain. The nurse's most appropriate action to assist in managing his pain would be to:
apply ice
The client with a gastric ulcer is admitted to the hospital. The nurse should assess the client for intake of which of substance that increases the risk of developing a gastric ulcer?
aspirin
The nurse is educating the client with gastroesophageal reflux disease (GERD) about ways to minimize symptoms. Which information in the client's history should the nurse address as indicators that needs to be changed?
bmi of 26, lifting weights, 2-4 cups of coffee per day
A client presents to the clinic with "bad pain" mid-abdomen, vomiting, and "not knowing what is wrong." Palpation reveals rebound tenderness with increased pain halfway between the umbilicus and the top of the pelvis. The client seems to have less pain when lying on the left side and flexing the knees. What is the best conclusion for the nurse to draw?
check for appendicitis
Which assessment is essential for the nurse to make when caring for a client who has just underwentan esophagogastroduodenoscopy (EGD)?
check gag reflex
The nurse would instruct a client with peptic ulcer disease to avoid intake of which type of food item?
chocolate
The nurse is caring for a client with a history of alcoholism. Which findings would indicate that the client has possibly developed chronic pancreatitis?
constipations and flatulence, fatty stools
The nurse is conducting dietary teaching with a client who has dumping syndrome. The nurse encourages the client to avoid which foods that the client usually enjoys?
cookies and fruit
An older adult male presents to the outpatient clinic reporting changes in bowel habits, increased diarrhea, thin stools, and some rectal bleeding. The nurse would be most concerned about which of the following?
dumping syndrome
As part of preparation for discharge for a client who has undergone a Billroth II surgical procedure for peptic ulcer disease, the nurse teaches the client about the possibility of dizziness, paleness, sweating, and feeling the heartbeat. The nurse explains that these symptoms are an indication of which of the following?
dumping syndrome
The nurse should encourage the client with dumping syndrome to avoid which of these foods?
fruit
In caring for a client with a hiatal hernia, which should be included in a teaching plan regarding causes?
heavy lifting
A nasogastric (NG) tube is ordered to be inserted in a client with a possible bowel obstruction. In preparation for this procedure, the nurse places the client in which position?
high fowlers
Which recommendation by the nurse to a client describes the best practice in an attempt to control diverticulosis?
high intake of dietary fiber
An older adult client has undergone a gastrointestinal diagnostic work-up, including endoscopy and upper GI series. Following these procedures, the nurse should make which priority assessment of the client?
hydration status
The client with diverticular disease is scheduled for a sigmoidoscopy and suddenly reports severe abdominal pain. On examination, the nurse notes a rigid abdomen with guarding. What action should the nurse take next?
notify HCP
In caring for a client 4 days post-cholecystectomy, the nurse notices that the drainage from the T-tube is 600 mL in 24 hours. Which is the appropriate action by the nurse?
notify the physician
The nurse is admitting a child with a diagnosis of "rule out appendicitis." The nurse assesses this client for which manifestations?
pain in lower right quadrant, elevated wbc, abdominal pain
A client with an ulcer below the pyloric valve would report which symptom?
pain on an empty stomach
The nurse explains to a certified nursing assistant (CNA) who is also a nursing student that the reason older adult clients are more prone to diverticulitis is because of which of the following?
poor deficient diet
The client returns to the nursing unit postoperatively after a colostomy. Which assessment data would require immediate action by the nurse?
stoma is blue
The client with irritable bowel syndrome (IBS) asks the nurse what causes the disease. Which response made by the nurse would be most appropriate?
the cause is unknown
A client with a history of hiatal hernia reports trouble sleeping because the pain is worse at night. Which response by the nurse is most appropriate?
try sleeping with the head of the bed elevated
