Subtopic gastrointestinal system
A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care? 1 Encouraging expression of concerns 2 Administering antibiotics as prescribed 3 Teaching the importance of getting rest 4 Explaining that everything will be all right
1 Encouraging expression of concerns Open communication helps to decrease anxiety. Antibiotics will have no direct effect on the client's anxiety. Knowledge does not always reduce anxiety and promote rest. Explaining that everything will be all right is false reassurance.
A nurse identifies a moderate amount of bright red blood in a client's gastric drainage four hours after a subtotal gastrectomy. What should the nurse do first? 1 Clamp the nasogastric tube. 2 Irrigate the tube gently with normal saline. 3 Record the observation and continue to monitor the drainage from the tube. 4 Reduce the pressure of the suction and record observations of the drainage characteristics.
3 Record the observation and continue to monitor the drainage from the tube. Some bright red blood at this point is an expected finding that should be monitored; large amounts of blood or bleeding should be reported immediately. Clamping the nasogastric tube is contraindicated; secretions will accumulate and cause pressure on the suture line. Also, clamping the tube prevents observation of gastric drainage. If the tube is draining, there is no need to irrigate; also, irrigations are traumatic. Reducing suction pressure allows secretions to accumulate and causes pressure on the suture line.
A client with achalasia is scheduled to have a bougienage to dilate the lower esophagus and cardiac sphincter. After the procedure the nurse assesses the client for what complications related to esophageal perforation? 1 Tachycardia and abdominal pain 2 Faintness and feelings of fullness 3 Diaphoresis and cardiac palpitations 4 Increased blood pressure and urinary output
1 Tachycardia and abdominal pain An increased heart rate is related to an autonomic nervous system response; pain is related to the trauma of the perforation and possibly gastric reflux. Faintness, feelings of fullness, diaphoresis, and cardiac palpitations are signs of dumping syndrome. An increased blood pressure may occur, but an increased urinary output has no relationship to esophageal perforation.
A client who is diagnosed with a duodenal ulcer asks, "Now that I have an ulcer, what comes next?" What is the nurse's best response? 1 "Most peptic ulcers heal with medical treatment." 2 "Clients with peptic ulcers have pain while eating." 3 "Early surgery is advisable, especially after the first attack." 4 "If ulcers are untreated, cancer of the stomach can develop."
1 "Most peptic ulcers heal with medical treatment." Treatment with medications, rest, diet, and stress reduction relieves symptoms, heals the ulcer, and prevents complications and recurrence. Clients with duodenal ulcers have pain after eating and especially at night; gastric ulcers cause pain during or close to eating. Surgery may be done after multiple recurrences and for treating complications. Perforation, pyloric obstruction, and hemorrhage, not cancer, are major complications.
A healthcare provider explains a cystectomy and an ileal conduit for a client with invasive carcinoma of the bladder. Later the client expresses concerns about the possibility of offensive odors associated with this procedure. What is the best response by the nurse? 1 "Tell me more about what you are thinking." 2 "Products are available to limit this problem." 3 "This is a problem, but the surgery is necessary." 4 "Most people who have this surgery share this same concern."
1 "Tell me more about what you are thinking." The response "Tell me more about what you are thinking" is an open-ended statement that focuses on the client's concerns and allows further verbalization of feelings. Although true, the response "This is a problem, but the surgery is necessary" may increase anxiety and cut off communication. The responses "Products are available to limit this problem" and "Most people who have this surgery share this same concern" move the focus away from the client and minimize the client's concerns.
The nurse is caring for an Asian client who had a laparoscopic cholecystectomy six hours ago. When asked whether there is pain, the client smiles and says, "No." What should the nurse do? 1 Monitor for nonverbal cues of pain 2 Check the pressure dressing for bleeding 3 Assist the client to ambulate around his room 4 Irrigate the client's nasogastric tube with sterile water
1 Monitor for nonverbal cues of pain Asian clients tend to be stoic regarding pain and usually do not acknowledge pain; therefore, the nurse should assess these clients further. This type of surgery does not require pressure dressings. First, the client must be assessed further for pain. If there is pain, the client should ambulate after, not before, receiving pain medication. Postoperatively, nasogastric tubes are irrigated when needed, not routinely.
A client with colitis has had a hemicolectomy. Three days after surgery the nurse identifies that the client has abdominal distention and absent bowel sounds, and has vomited 300 mL of dark green viscous fluid. The nurse contacts the primary healthcare provider and recommends which intervention? 1 Nasogastric tube for decompression 2 Antiemetic for nausea/vomiting 3 Intravenous (IV) lactated Ringer for fluid replacement 4 Stat electrolytes to assess for probable electrolyte imbalance
1 Nasogastric tube for decompression Decompression removes collected secretions behind the nonfunctioning bowel segment (paralytic ileus), thus reducing pressure on the suture line and allowing healing. Vomiting will subside as the bowel is decompressed. Although IV lactated Ringer for fluid replacement is important, the primary concern is decompression of the bowel; the amount of fluid removed will direct fluid and electrolyte replacement therapy.
A client has surgery for an incarcerated hernia. The healthcare provider returns the incarcerated tissue to the abdominal cavity and uses a mesh to reinforce the muscle wall. What specific instructions should be included in the discharge instructions? 1 Reduce dietary roughage. 2 Avoid lifting heavy items. 3 Increase dietary potassium intake. 4 Keep the head of the bed elevated.
2 Avoid lifting heavy items. Avoiding lifting helps prevent increased intraabdominal pressure that may disrupt the surgical repair. Roughage helps prevent constipation, thus avoiding straining and increased intraabdominal pressure. There is no indication for potassium supplements. The client can assume any position of comfort.
A nurse is reviewing a list of current medications with a client who has developed gastrointestinal bleeding. Which medication prescription should the nurse discuss with the primary healthcare provider? 1 Digoxin 2 Ibuprofen 3 Famotidine 4 Atorvastatin
2 Ibuprofen Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that can cause bleeding in the gastrointestinal (GI) tract; clients with a history of GI bleeding should not take NSAIDs. Digoxin is an antidysrhythmic used to slow and strengthen the heart rate; it does not contribute to GI bleeding. Atorvastatin is a cholesterol-reducing drug and is not contraindicated with GI bleeding. Famotidine is a histamine (H2) blocker to reduce acid secretion in the stomach; it does not cause GI bleeding.
A client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. Which diet can the nurse expect will be prescribed for this client based upon the assessment? 1 No protein 2 Moderate protein 3 High protein 4 Strict protein restriction
2 Moderate protein Because the liver is unable to detoxify ammonia to urea and the client is experiencing impending hepatic encephalopathy coma, protein intake should be moderate. Strict protein and no protein restrictions are not required because clients need protein for healing. High protein is contraindicated in hepatic encephalopathy.
The nurse is taking care of a client with cirrhosis of the liver and ascites. Which lunch is the best choice for a client with this disorder? 1 Ham sandwich with cheese, whole milk, and potato chips 2 Penne pasta, spinach, banana, and decaffeinated iced tea 3 Baked lasagna with sausage, salad, and milkshake 4 Hamburger, french fries, and cola
2 Penne pasta, spinach, banana, and decaffeinated iced tea A client with cirrhosis and ascites will require moderate to low fat and low sodium (penne pasta, spinach, banana, and decaffeinated iced tea). Caffeine can stimulate and cause distention. Ham, cheese, whole milk, potato chips, baked lasagna with sausage, milkshake, hamburger, french fries, and cola all have more fat and sodium than a client with cirrhosis should consume.
An older client with diarrhea is admitted to the hospital from a nursing home. A stool specimen confirms a diagnosis of a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse making room assignments asks if it is possible to place the new client with another client that also has MRSA in the same isolation room. How should the nurse respond? 1 "The other person's infection is not contagious." 2 "This is the usual practice when antibiotic therapy is started." 3 "It is safe to place people with the same infection in one room." 4 "As soon as a private room becomes available we will move the client."
3 "It is safe to place people with the same infection in one room." There is no need to separate one client with MRSA from another client with the same infection. MRSA infections are highly contagious. MRSA infections are resistant to most antibiotics, especially methicillin. Clients with the same infection can remain in the same room; contact precautions are necessary to protect visitors and staff members.
