13 NCLEX QUESTIONS - Various

When assessing the client with the diagnosis of peptic ulcer disease, which physical examination should the nurse implement first? 1. Auscultate the client's bowel sounds in all four quadrants. 2.Palpate the abdominal area for tenderness. 3.Percuss the abdominal borders to identify organs. 4.Assess the tender area progressing to nontender

1. Auscultate the client's bowel sounds in all four quadrants. REASON: Auscultation should be used prior to palpa-tion or percussion when assessing the abdomen. If the nurse manipulates the abdomen, the bowel sounds can be altered and give false information

The nurse teaches the client about an anti-ulcer diet. Which of the following statements by the client indicates to the nurse that dietary teaching was successful? 1. "I must eat bland foods to help my stomach heal." 2. "I can eat most foods, as long as they don't bother my stomach." 3. "I cannot eat fruits and vegetables because they cause too much gas." 4. "I should eat a low-fiber diet to delay gastric emptying -

2. "I can eat most foods, as long as they don't bother my stomach."

The nurse finds a client who has been diagnosed with a peptic ulcer surrounded by papers from his briefcase and arguing on the telephone with a coworker. The nurse's response to observing these actions should be based on knowledge that: 1. Involvement with his job will keep the client from becoming bored. 2. A relaxed environment will promote ulcer healing. 3. Not keeping up with his job will increase the client's stress level. 4. Setting limits on the client's behavior is an important nursing responsibility.

2. A relaxed environment will promote ulcer healing. REASON: A relaxed environment is an essential component of ulcer healing. Nurses can help clients understand the importance of relaxation and explore with them ways to balance work and family demands to promote healing. Being involved with his work may prevent boredom; however, this client is upset and argumentative. Not keeping up with his job will probably increase the client's stress level, but the nurse's response is best if it is based on the fact that a relaxed environment is an essential component of ulcer healing. Nurses cannot set limits on a client's behavior; clients must make the decision to make lifestyle change

The nurse is teaching the patient a client with apeptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by thenurse would be most accurate? 1. Aspirin 2. Acetaminophen 3. Naproxen 4. Ibuprofen

2. Acetaminophen REASON: Acetaminophen is recommended for painrelief because it does no promote irritationof the mucosa. Aspirin, and nonsteroidal anti-inflammatory drugs suchs as naproxen andibuprofen, may cause irritation of the mucosaand subsequent bleeding

A client with peptic ulcer disease tells the nurse that he has black stools, which he has not reported to his physician. Based on this information, which nursing diagnosis would be appropriate for this client? 1. Ineffective coping related to fear of diagnosis of chronic illness 2. Deficient knowledge related to unfamiliarity with significant signs and symptoms. 3. Constipation related to decreased gastric motility. 4. Imbalanced nutrition: Less than body requirements related to gastric bleeding.

2. Deficient knowledge related to unfamiliarity with significant signs and symptoms. REASON: Black, tarry stools are an important warning sign of bleeding in peptic ulcer disease. Digested blood in the stool causes it to be black. The odor of the stool is very offensive. Clients with peptic ulcer disease should be instructed to report the incidence of black stools promptly to their primary health care provider. The data do not support the other diagnoses.

The nurse is preparing to teach a client with a peptic ulcer about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of which of the following? 1. Bland foods. 2. High-protein foods. 3. Any foods that are tolerated. 4. Large amounts of milk.

3. Any foods that are tolerated. REASON: Diet therapy for ulcer disease is a controversial issue. There is no scientific evidence that diet therapy promotes healing. Most clients are instructed to follow a diet that they can tolerate. There is no need for the client to ingest only a bland or high-protein diet. Milk may be included in the diet, but it is not recommended in excessive amounts.

Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions? 1. Decrease daily intake of vegetables and water, and ambulate frequently 2. Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes. 3. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating 4. Avoid over-the-counter drugs that have antacids in them

3. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating REASON: Eating small and frequent meals requires less release of hydrochloric acid. Remaining in an upright position for 30 minutes after meals prevents reflux into the esophagus which is often exacerbated when lying down, expecially after a large meal which makes the patient tired

A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid? 1. "I should take my antacid before I take my other medications." 2. "I need to decrease my intake of fluids so that I don't dilute the effects of my antacid." 3. "My antacid will be most effective if I take it whenever I experience stomach pains." 4. "It is best for me to take my antacid 1 to 3 hours after meals."

4. "It is best for me to take my antacid 1 to 3 hours after meals.". REASON: Antacids are most effective if taken 1 to 3 hours after meals and at bedtime. When an antacid is taken on an empty stomach, the duration of the drug's action is greatly decreased. Taking antacids 1 to 3 hours after a meal lengthens the duration of action, thus increasing the therapeutic action of the drug. Antacids should be administered about 2 hours after other medications to decrease the chance of drug interactions. It is not necessary to decrease fluid intake when taking antacids. If antacids are taken more frequently than recommended, the likelihood of developing adverse effects increases. Therefore, the client should not take antacids as often as desired to control pain.

Which assessment data support the client's diagnosis of gastric ulcer? 1. Presence of blood in the client's stool for the past month. 2.Complaints of a burning sensation that moves like a wave. 3.Sharp pain in the upper abdomen after eating a heavy meal. 4. Comparison of complaints of pain with ingestion of food and sleep

4. Comparison of complaints of pain with ingestion of food and sleep REASON: In a client diagnosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with duodenal ulcer has pain durin ghte night that is often relieved by eating food. Pain occurs 1-3 hours after meals

A client with a peptic ulcer reports epigastric pain that frequently awakens her during the night. The nurse should instruct the client to do which activities? Select all that apply. 1. Obtain adequate rest to reduce stimulation. 2. Eat small, frequent meals throughout the day. 3. Take all medications on time as ordered. 4. Sit up for one hour when awakened at night. 5. Stay away from crowded areas.

1. Obtain adequate rest to reduce stimulation. 2. Eat small, frequent meals throughout the day. 3. Take all medications on time as ordered. 4. Sit up for one hour when awakened at night. REASON: The nurse should encourage the client to reduce stimulation that may enhance gastric secretion. The nurse can also advise the client to utilize health practices that will prevent recurrences of ulcer pain, such as avoiding fatigue and elimination of smoking. Eating small, frequent meals helps to prevent gastric distention if not actively bleeding and decreases distension and release of gastrin. Medications should be administered promptly to maintain optimum levels. After awakening during the night, the client should eat a small snack and return to bed, keeping the head of the bed elevated for an hour after eating. It is not necessary to stay away from crowded areas.

Which of the following would be an expected outcome for a client with peptic ulcer disease? The client will: 1. Demonstrate appropriate use of analgesics to control pain. 2. Explain the rationale for eliminating alcohol from the diet. 3. Verbalize the importance of monitoring hemoglobin and hematocrit every 3 months. 4. Eliminate contact sports from his or her lifestyle.

2. Explain the rationale for eliminating alcohol from the diet. REASON: Alcohol is a gastric irritant that should be eliminated from the intake of the client with peptic ulcer disease. Analgesics are not used to control ulcer pain; many analgesics are gastric irritants. The client's hemoglobin and hematocrit typically do not need to be monitored every 3 months, unless gastrointestinal bleeding is suspected. The client can maintain an active lifestyle and does not need to eliminate contact sports as long as they are not stress-inducing.

A client with peptic ulcer disease reports that he has been nauseated most of the day and is now feeling light-headed and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. 1. Administering an antacid hourly until nausea subsides. 2. Monitoring the client's vital signs. 3. Notifying the physician of the client's symptoms. 4. Initiating oxygen therapy. 5. Reassessing the client in an hour.

2. Monitoring the client's vital signs. 3. Notifying the physician of the client's symptoms. REASON: The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client's vital signs and notify the physician of the client's symptoms. To administer an antacid hourly or to wait 1 hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.

When obtaining a nursing history on a client with a suspected gastric ulcer, which signs and symptoms should the nurse expect to assess? Select all that apply. 1. Epigastric pain at night. 2. Relief of epigastric pain after eating. 3. Vomiting. 4. Weight loss. 5. Melena - dark tarry stool

3. Vomiting. 4. Weight loss. 5. Melena. REASON: Vomiting and weight loss are common with gastric ulcers. The client may also have blood in the stools (melena) from gastric bleeding. Clients with a gastric ulcer are most likely to complain of a burning epigastric pain that occurs about 1 hour after eating. Eating frequently aggravates the pain. Clients with duodenal ulcers are more likely to complain about pain that occurs during the night and is frequently relieved by eating.

The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1. Bradycardia 2. Numbness in the legs 3. Nausea and vomiting 4. A rigid, board-like abdomen

4. A rigid, board-like abdomen REASON: Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which become rigid and board-like. Nausea and vomiting may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding

A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level. C. Performing a fecal occult blood test and administering IV calcium gluconate. D. Starting parenteral nutrition and placing the patient in high-Fowler's position

A. Providing IV fluids and inserting a nasogastric tube REASON: A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient's suspected diagnosis and parenteral nutrition is not a priority in the short term

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? A. "I can have a glass of low-fat milk at bedtime." B. "I will have to eliminate all spicy foods from my diet." C. "I will have to use herbal teas instead of caffeinated drinks." D. "I should keep something in my stomach all the time to neutralize the excess acids."

C. "I will have to use herbal teas instead of caffeinated drinks." REASON: Patients with gastroesophageal reflux disease should avoid foods (such as tea and coffee) that decrease lower esophageal pressure. Patients should also avoid milk, especially at bedtime, as it increases gastric acid secretion. Patients may eat spicy foods, unless these foods cause reflux. Small, frequent meals help prevent overdistention of the stomach, but patients should avoid late evening meals and nocturnal snacking.

What are signs and symptoms of dumping syndrome?

Fullness, weakness, palpitations, cramping, faintness, diarrhea. Lower GI symptoms. IF patient sits up after they eat.

What is the process of dumping syndrome?

Gastric contents move in the right direction at the incorrect rate.

Treatment for dumping syndrome? Head of Bed, diet, carbs?

HOB: Low (left side) Diet: low fluids with meals Carbs: Low carbs

What is dumping syndrome?

This is when the stomach empties quickly after eating and the client experiences uncomfortable to severe side effects. Usually secondary to gastric bypass, gastrectomy or gall bladder disease

A nurse is receiving the record of a client with Crohn's disease. what type of stool characteristics with the nurse expect to see documented and recorded

diarrhea

The nurse explains to the patient with gastroesophageal reflux disease that this disorder:

often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the espophagus REASON: The acidic contents of the stomach touching the inside of the esophagus are responsible for the physical sensation known as "heart-burn" that is a cardinal symptom of GERD

A nurse is monitoring a patient for the early signs and symptoms of dumping syndrome. what symptoms indicate this occurrence?

sweating and pallor