GI: Nurselabs P2
The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy? A. "The cimetidine (Tagamet) will cause me to produce less stomach acid." B. "Sucralfate (Carafate) will change the fluid in my stomach." C. "Antacids will coat my stomach." D. "Omeprazole (Prilosec) will coat the ulcer and help it heal."
A. "The cimetidine (Tagamet) will cause me to produce less stomach acid." Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of gastric acid. The H2-receptor antagonist cimetidine competitively blocks histamine from stimulating the H2-receptors located on the gastric parietal cells (these cells are responsible for hydrochloric acid secretion and secretion of the intrinsic factor). The effect results in reducing the volume of gastric acid secretion from stimuli, including histamine, food, caffeine, and insulin.
Christina is receiving an enteral feeding that requires a concentration of 80 ml of supplement mixed with 20 ml of water. How much water do you mix with an 8 oz (240ml) can of feeding? A. 60 ml B. 70 ml C. 80 ml D. 90 ml
A. 60 ml Dosage problem. It's 80/20 = 240/X. X=60. There are many different formulas that are used for enteral nutrition, and each formula is specific to the medical condition. For example, there are formulas for relatively healthy people, and those with cancer, diabetes, and kidney or liver disease, among other medical conditions. Most formulas will provide between 1.0-2.0 calories per mL of formula.
You're preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he's anxious. What should your initial step be in working with this patient? A. Determine what the patient already knows about colostomies. B. Show the patient some pictures of colostomies. C. Arrange for someone who has a colostomy to visit the patient. D. Provide the patient with written material about colostomy care.
A. Determine what the patient already knows about colostomies. Initially, you should assess the patient's knowledge about colostomies and how it will affect his lifestyle. Review anatomy, physiology, and implications of surgical intervention. Discuss future expectations, including anticipated changes in the character of effluent. Provides knowledge base from which the patient can make informed choices, and offers an opportunity to clarify misconceptions regarding an individual situation.
The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record? A. Diarrhea B. Chronic constipation C. Constipation alternating with diarrhea D. Stools constantly oozing from the rectum
A. Diarrhea Crohn's disease is characterized by non-bloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. In CD, the inflammation extends through the entire thickness of the bowel wall from the mucosa to the serosa. The disease runs a relapsing and remitting course. The other options are not associated with diarrhea.
A female client being seen in a physician's office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? A. Fast for 8 hours before the test B. Eat a regular supper and breakfast C. Continue to take all oral medications as scheduled D. Monitor own bowel movement pattern for constipation
A. Fast for 8 hours before the test. A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test, depending on physician instructions. The barium swallow study, also known as a barium esophagogram or esophagram, is a contrast-enhanced radiographic study commonly used to assess structural characteristics of the entire esophagus.
Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is the appropriate action for the nurse to take? A. Hold the feeding B. Reinstill the amount and continue with administering the feeding C. Elevate the client's head at least 45 degrees and administer the feeding D. Discard the residual amount and proceed with administering the feeding
A. Hold the feeding Unless specifically indicated, residual amounts more than 100 mL require holding the feeding. Gastric residual refers to the volume of fluid remaining in the stomach at a point in time during enteral nutrition feeding. Nurses withdraw this fluid via the feeding tube by pulling back on the plunger of a large (usually 60 mL) syringe at intervals typically ranging from four to eight hours.
Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown? A. Ileostomy B. Ascending colostomy C. Transverse colostomy D. Descending colostomy
A. Ileostomy The output from an Ileostomy is described. The consistency of the ileostomy output will be liquid to pasty, depending on one's diet, medications, and other factors. Because the output is constant, the pouch will need to be emptied 5-8 times a day. Average ileostomy output ranges from 800 - 1,200 milliliters (mL) or 3 - 5 cups per day. Right after surgery, output may be watery. During the first few weeks after surgery, the output should thicken to the consistency of applesauce.
The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that will assist in the insertion would be: A. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion. B. After insertion into the nostril, instruct the client to extend his neck. C. Introduce the tube with the client's head tilted back, then instruct him to keep his head upright for final insertion. D. Instruct the client to hold his chin down, then back for insertion of the tube.
A. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion. NG insertion technique is to have the client first tilt his head back for insertion into the nostril, then to flex his neck forward and swallow. A common error when placing the tube is to direct the tube in an upward direction as it enters the nares; this will cause the tube to push against the top of the sinus cavity and cause increased discomfort. The tip should instead be directed parallel to the floor, directly toward the back of the patient's throat.
A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to: A. Reduce gastric acid output. B. Protect the ulcer surface. C. Inhibit the production of hydrochloric acid (HCl). D. Inhibit vagus nerve stimulation.
A. Reduce gastric acid output. These drugs inhibit the action of histamine on the H2 receptors of parietal cells, thus reducing gastric acid output. The H2-receptor antagonist cimetidine competitively blocks histamine from stimulating the H2-receptors located on the gastric parietal cells (these cells are responsible for hydrochloric acid secretion and secretion of the intrinsic factor). The effect results in reducing the volume of gastric acid secretion from stimuli, including histamine, food, caffeine, and insulin.
What information is correct about stomach cancer? A. Stomach pain is often a late symptom. B. Surgery is often a successful treatment. C. Chemotherapy and radiation are often successful treatments. D. The patient can survive for an extended time with TPN.
A. Stomach pain is often a late symptom. Stomach pain is often a late sign of stomach cancer; outcomes are particularly poor when cancer reaches that point. In the United States, most patients have symptoms of an advanced stage at the time of presentation. The most common presenting symptoms for gastric cancers are non-specific weight loss, persistent abdominal pain, dysphagia, hematemesis, anorexia, nausea, early satiety, and dyspepsia.
The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? A. Sweating and pallor B. Bradycardia and indigestion C. Double vision and chest pain D. Abdominal cramping and pain
A. Sweating and pallor Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. In early dumping, the symptoms usually occur within 10 to 30 minutes after a meal. The rapid transit of hyperosmolar chyme from the stomach into the duodenum causes fluid to shift from the vasculature to the intestinal lumen, leading to increased volume in the small bowel.
A patient has an acute upper GI hemorrhage. Your interventions include: A. Treating hypovolemia. B. Treating hypervolemia. C. Controlling the bleeding source. D. Treating shock and diagnosing the bleeding source.
A. Treating hypovolemia. A patient with an acute upper GI hemorrhage must be treated for hypovolemic and hemorrhagic shock. Monitor patient's vital signs, especially BP and HR. Look for signs of orthostatic hypotension. Hypotension and tachycardia are initial compensatory mechanisms usually noted with bleeding. Orthostasis (a drip of 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP when changing from supine to sitting position) indicates reduced circulating fluids.
If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client? A. Blood replacement B. Antacid administration C. Nasogastric tube suction D. Fluid and electrolyte replacement
B. Antacid administration Antacids aren't helpful in perforation. The client should be treated with antibiotics. Perforation of the stomach is a full-thickness injury of the wall of the organ. Since peritoneum completely covers the stomach, perforation of the wall creates a communication between the gastric lumen and the peritoneal cavity. If the perforation occurs acutely, there is no time for an inflammatory reaction to wall off the perforation, and the gastric content is free to enter the general peritoneal cavity, causing chemical peritonitis.
The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? A. Irrigating the drain B. Avoiding coughing C. Maintaining bed rest D. Restricting pain medication
B. Avoiding coughing. Coughing is avoided following umbilical hernia repair to prevent disruption of tissue integrity, which can occur because of the location of this surgical procedure. Splint the stomach by placing a pillow over the abdomen with firm pressure before coughing or movement to help reduce the pain.
The nurse is caring for a male client postoperatively following the creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care? A. Sexual dysfunction B. Body image, disturbed C. Fear related to poor prognosis D. Nutrition: more than body requirements, imbalanced
B. Body image, disturbed Body image, disturbed relates to loss of bowel control, the presence of a stoma, the release of fecal material onto the abdomen, the passage of flatus, odor, and the need for an appliance (external pouch). Encourage the patient/SO to verbalize feelings regarding the ostomy. Acknowledge normality of feelings of anger, depression, and grief over a loss. Discuss daily "ups and downs" that can occur.
Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication? A. Fistula B. Bowel perforation C. Bowel obstruction D. Abscess
B. Bowel perforation An inflammatory condition that affects the surface of the colon, ulcerative colitis causes friability and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel perforation, toxic megacolon, hemorrhage, cancer, and other anorectal and systemic complications. Colonic perforations are usually a complication of a toxic megacolon. However, perforation can also present in severe ulcerative colitis even in the absence of toxic megacolon. Most perforations occur in the left colon, commonly in the sigmoid colon.
Findings during an endoscopic exam include a cobblestone appearance of the colon in your patient. The findings are characteristic of which disorder? A. Ulcer B. Crohn's disease C. Chronic gastritis D. Ulcerative colitis
B. Crohn's disease Crohn's disease penetrates the mucosa of the colon through all layers and destroys the colon in patches, which creates a cobblestone appearance. As the inflammation progresses, non-caseating granulomas form involving all layers of the intestinal wall. It can develop into the classic cobblestone mucosal appearances and skip lesions along the length of the intestine sparing areas with normal mucosa.
The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client? A. Limit oral fluid B. Elevate the scrotum C. Apply heat to the abdomen D. Remain in a low-fiber diet
B. Elevate the scrotum. Following inguinal hernia repair, the client should be instructed to elevate the scrotum and apply ice packs while in bed to decrease pain and swelling. The nurse also should instruct the client to apply a scrotal support when out of bed. In the beginning phases of healing, the body produces extra fluid that helps with the healing process. This fluid brings nutrients and cells that can help tissues repair themselves, and appears as swelling at the site where there was an injury to the tissues (similar to swelling after a sprained ankle). When this swelling sits in one area for a few days, it often turns hard and can feel like a firm lump.
A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: A. Cancer of the stomach B. Peptic ulcer disease C. Chronic gastritis D. Pylorospasm
B. Peptic ulcer disease Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Peptic ulcer disease is characterized by discontinuation in the inner lining of the gastrointestinal (GI) tract because of gastric acid secretion or pepsin. It extends into the muscularis propria layer of the gastric epithelium. It usually occurs in the stomach and proximal duodenum.
An intubated patient is receiving continuous enteral feedings through a Salem pump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml. What is your first response to this finding? A. Notify the doctor immediately. B. Stop the feeding, and clamp the NG tube. C. Discard the 220ml and clamp the NG tube. D. Give a prescribed GI stimulant such as metoclopramide (Reglan).
B. Stop the feeding, and clamp the NG tube. A gastric residual greater than 2 hours worth of feeding or 100-150ml is considered too high. The feeding should be stopped; the NG tube clamped, and then allowed time for the stomach to empty before additional feeding is added. Gastric residual volume is the amount of liquid drained from a stomach following administration of enteral feed; this liquid consists mainly of infused nutritional formula or water, and secreted GI juice. Gastric residual volume is measured either by aspiration using a syringe, or by gravity drainage to a reservoir.
To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid? A. 4 B. 6 C. 8 D. 10
C. 8 Bulk-forming laxatives must be given with at least 8 ounces of liquid plus additional liquid each day to prevent intestinal obstruction. Bulk-forming laxatives retain fluid in the stool and increase stool weight and consistency. Psyllium, dietary fiber, carboxymethylcellulose, and methylcellulose are common examples. It is important to take ample amounts of water for bulk-forming agents to work. Lack of water, in turn, leads to bloating and can cause bowel obstruction.
When administering sucralfate (Carafate) to a patient with a nasogastric tube, it is important to: A. Crush the tablet into a fine powder before mixing with water. B. Administer with a bolus tube feeding. C. Allow the tablet to dissolve in water before administering. D. Administer with an antacid for maximum benefit.
C. Allow the tablet to dissolve in water before administering. It is important to give sucralfate on an empty stomach so that it may dissolve and form a protective barrier over the gastric mucosa. Sucralfate exhibits its action by forming a protective layer, increasing bicarbonate production, exhibiting anti-peptic effects, promoting tissue growth, regeneration, and repair. Why not A: -The tablet form will not dissolve in water when crushed; it must be left whole and allowed to dissolve. Crushing the medication so that it will not dissolve could lead to clogging of the nasogastric tube and decreased effectiveness of the drug.
Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would: A. Position the client supine to assist in medication absorption B. Aspirate the nasogastric tube after medication administration to maintain patency C. Clamp the nasogastric tube for 30 minutes following administration of the medication D. Change the suction setting to low intermittent suction for 30 minutes after medication administration
C. Clamp the nasogastric tube for 30 minutes following administration of the medication. If a client has a nasogastric tube connected to suction, the nurse should wait up to 30 minutes before reconnecting the tube to the suction apparatus to allow adequate time for medication absorption. Flush 10 ml of water between medications. This step prevents interactions between medications. After the last medication has been given, flush the tube with 30 ml of water. Flushing prevents blocking of the tube.
A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably include: A. Antacids B. Antibiotics C. Corticosteroids D. Histamine2-receptor blockers
C. Corticosteroids Medications to control inflammation such as corticosteroids are used for long-term treatment. First-line treatment is sulfasalazine and 5-aminosalicylates, given orally or rectally, which have a remission rate of about 50%. Glucocorticoids, orally or rectally, can be added for those who fail to achieve remission within two weeks. Except for glucocorticoids, all of these medications can be used in the maintenance of remission.
A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse would offer which full liquid item to the client? A. Tea B. Gelatin C. Custard D. Popsicle
C. Custard Full liquid food items include items such as plain ice cream, sherbet, breakfast drinks, milk, pudding, and custard, soups that are strained, and strained vegetable juices. A clear liquid diet consists of foods that are relatively transparent. A patient prescribed a full liquid diet follows a specific diet type requiring all liquids and semi-liquids but no forms of solid intake.
Sucralfate (Carafate) achieves a therapeutic effect by: A. Neutralizing gastric acid. B. Enhancing gastric absorption. C. Forming a protective barrier around gastric mucosa. D. Inhibiting gastric acid secretion.
C. Forming a protective barrier around gastric mucosa. Sucralfate has a local effect only on the gastric mucosa. It forms a paste-like substance in the stomach, which adheres to the gastric lining, protecting against adverse effects related to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.
The student nurse is participating in a colorectal cancer screening program. Which patient has the fewest risk factors for colon cancer? A. Janice, a 45 y.o. with a 25-year history of ulcerative colitis. B. George, a 50 y.o. whose father died of colon cancer. C. Herman, a 60 y.o. who follows a low-fat, high-fiber diet. D. Sissy, a 72 y.o. with a history of breast cancer.
C. Herman, a 60 y.o. who follows a low-fat, high-fiber diet. Large population studies with variable strength evidence have found CRC protective factors such as physical activity, diet (fruits and vegetables, fiber, resistant starch, fish), vitamin supplements (folate, folic acid, pyridoxine B6, calcium, vitamin D, magnesium), garlic and coffee, and drugs [aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), hormonal replacement therapy in postmenopausal, statins, bisphosphonate and angiotensin inhibitors].
Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate? A. He has fresh, active upper GI bleeding. B. He needs immediate saline gastric lavage. C. His gastric bleeding occurred 2 hours earlier. D. He needs a transfusion of packed RBCs.
C. His gastric bleeding occurred 2 hours earlier. Coffee-ground emesis occurs when there is upper GI bleeding that has undergone gastric digestion. For blood to appear as coffee-ground emesis, it would have to be digested for approximately 2 hours. The term "coffee-grounds" describes gastric aspirate or vomitus that contains dark specks of old blood. UGIB is classified as any blood loss from a gastrointestinal source above the ligament of Treitz.
When a client has peptic ulcer disease, the nurse would expect a priority intervention to be: A. Assisting in inserting a Miller-Abbott tube. B. Assisting in inserting an arterial pressure line. C. Inserting a nasogastric tube. D. Inserting an I.V.
C. Inserting a nasogastric tube. An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. Monitor the client's fluid intake and urine output. Assess for the signs of hematemesis or melena. The client with a bleeding ulcer may vomit bright red blood or coffee grounds emesis. Melena occurs when there is bleeding in the upper GI tract.
The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? A. Ambulate following a meal B. Eat high carbohydrate foods C. Limit the fluid taken with meal D. Sit in a high-Fowler's position during meals
C. Limit the fluid taken with meals. Dumping syndrome is a term that refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II procedure. Early manifestations usually occur within 30 minutes of eating and include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down. The nurse should instruct the client to decrease the amount of fluid taken at meals.
The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? A. Palpates the abdomen for size B. Palpates the liver at the right rib margin C. Listens to bowel sounds in all four quadrants D. Percusses the right lower abdominal quadrant
C. Listens to bowel sounds in all four quadrants The appropriate sequence for abdominal examination is inspection, auscultation, percussion, and palpation. Auscultation is performed after inspection to ensure that the motility of the bowel and bowel sounds are not altered by percussion or palpation. Therefore, after inspecting the skin on the abdomen, the nurse should listen for bowel sounds.
The client with a duodenal ulcer may exhibit which of the following findings during an assessment? A. Hematemesis B. Malnourishment C. Melena D. Pain with eating
C. Melena The client with a duodenal ulcer may have bleeding at the ulcer site, which shows up as melena (black tarry stool). Duodenal ulcers occur when there is a disruption to the surface of the mucosa of the duodenum. These ulcers are part of peptic ulcer disease, which involves the stomach and first part of the duodenum. The other findings are consistent with a gastric ulcer. - The pain associated with duodenal ulcers improves after meals, while the pain associated with gastric ulcers generally intensifies after meals.
The most important pathophysiological factor contributing to the formation of esophageal varices is: A. Decreased prothrombin formation. B. Decreased albumin formation by the liver. C. Portal hypertension. D. Increased central venous pressure.
C. Portal hypertension As the liver cells become fatty and degenerate, they are no longer able to accommodate a large amount of blood necessary for homeostasis. The pressure in the liver increases and causes increased pressure in the venous system. As the portal pressure increases, fluid exudes into the abdominal cavity. This is called ascites.
A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in place and is connected to low continuous suction. During the immediate postoperative period, you expect the gastric secretions to be which color? A. Brown B. Clear C. Red D. Yellow
C. Red Normally, drainage is bloody for the first 24 hours after a partial gastrectomy; then it changes to brown-tinged and then to yellow or clear. Drainage will be bloody for the first 12 hours, and then should clear and turn greenish. Continued or recurrent bleeding suggests complications. A decline in output may reflect the return of GI function.
A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy? A. Halts stress reactions B. Heals the gastric mucosa C. Reduces the stimulus to acid secretions D. Decreases food absorption in the stomach
C. Reduces the stimulus to acid secretions. A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion. A vagotomy is a type of surgery that removes all or part of the vagus nerve. This nerve runs from the bottom of the brain, through the neck, and along the esophagus, stomach, and intestines in the gastrointestinal (GI) tract.
The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to: A. Check that the hemostat is on the bedside. B. Monitor IV fluids for the shift. C. Regularly assess respiratory status. D. Check that the balloon is deflated on a regular basis.
C. Regularly assess respiratory status. The respiratory system can become occluded if the balloon slips and moves up the esophagus, putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.
Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications? A. To inhibit mucus production. B. To neutralize acid production. C. To stimulate mucus production. D. To stimulate hydrogen ion diffusion back into the mucosa.
C. To stimulate mucus production. The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion diffusion back into the mucosa, resulting in accelerated ulcer healing. Sucralfate, a polymer of sucrose with aluminum hydroxide, forms a protective coating on the mucosal lining, particularly in ulcerated areas. In the presence of acid, it becomes a gel that adheres to epithelial cells and ulcer craters.
Dark, tarry stools indicate bleeding in which location of the GI tract? A. Upper colon B. Lower colon C. Upper GI tract D. Small intestine
C. Upper GI tract Melena is the passage of dark, tarry stools that contain a large amount of digested blood. It occurs with bleeding from the upper GI tract. The clinical presentation can vary but should be well-characterized. Hematemesis is the overt bleeding with vomiting of fresh blood or clots. Melena refers to dark and tarry-appearing stools with a distinctive smell. The term "coffee-grounds" describes gastric aspirate or vomitus that contains dark specks of old blood.
Your patient Maria takes NSAIDS for her degenerative joint disease, and has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease? A. calcium carbonate (Tums) B. famotidine (Pepcid) C. misoprostol (Cytotec) D. sucralfate (Carafate)
C. misoprostol (Cytotec) Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish the prostaglandins. Currently, misoprostol is FDA-approved only for the prevention and treatment of NSAID-induced gastric ulcers in patients taking NSAIDs and at high risk for ulceration. It has an indication (but not FDA approved) in the short-term treatment of active duodenal or gastric ulcers with other etiologies.
A nurse is preparing to care for a female client with esophageal varices who just had a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times? A. An obturator B. Kelly clamp C. An irrigation set D. A pair of scissors
D. A pair of scissors When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the client's bedside at all times. The client needs to be observed for sudden respiratory distress, which occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs, the nurse immediately cuts all balloon lumens and removes the tube. Sengstaken-Blakemore tube placement is indicated for unstable patients with uncontrolled hemorrhage. Sengstaken-Blakemore tube placements can temporarily control the hemorrhage.
The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? A. Bradycardia B. Numbness in the legs C. Nausea and vomiting D. A rigid, board-like abdomen
D. A rigid, board-like abdomen Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the mid epigastric area and spreading over the abdomen, which becomes rigid and board-like. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with an acute abdomen that carries a high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries mortality ranging from 1.3% to 20%.
The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves: A. Cutting the vagus nerve. B. Removing the distal portion of the stomach. C. Removal of the ulcer and a large portion of the cells that produce hydrochloric acid. D. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.
D. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum. Pyloroplasty is surgery to widen the opening in the lower part of the stomach (pylorus) so that stomach contents can empty into the small intestine (duodenum). The pylorus is a thick, muscular area. When it thickens, food cannot pass through.
A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic therapy, which nursing action would be most effective in ensuring safe care? A. Measuring serum potassium for hyperkalemia B. Assessing the client for hypervolemia C. Measuring the client's weight weekly D. Documenting precise intake and output
D. Documenting precise intake and output. For the client with ascites receiving diuretic therapy, careful intake and output measurement are essential for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and documented, could place the client at risk for serious fluid and electrolyte imbalances. The most common adverse effect for any diuretic is mild hypovolemia, which can lead to transient dehydration and increased thirst. When there is an over-treatment with a diuretic, this could lead to severe hypovolemia, causing hypotension, dizziness, and syncope.
Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy? A. Peristalsis B. Gastric acidity C. Gastric motility D. Gastric pH
D. Gastric pH If the vagus nerve is cut as it enters the stomach, gastric acid secretion is decreased, but intestinal motility is also decreased and gastric emptying is delayed. Because gastric acids are decreased, gastric pH increases. The postoperative complications of truncal vagotomy are well documented. Resection of the vagal nerve trunks above the celiac and hepatic branches (differentiates TV versus SV) leads to parasympathetic denervation of the pylorus, liver, biliary tree, pancreas, and small and large intestines.
You promote hemodynamic stability in a patient with upper GI bleeding by: A. Encouraging oral fluid intake. B. Monitoring central venous pressure. C. Monitoring laboratory test results and vital signs. D. Giving blood, electrolyte, and fluid replacement.
D. Giving blood, electrolyte, and fluid replacement. To stabilize a patient with acute bleeding, NS or LR solution is given I.V. until BP rises and urine output returns to 30ml/hr. Two large-caliber (18-gauge or larger) peripheral I.V. catheters or a central venous catheter should be inserted. For patients who are hemodynamically unstable, two 16-gauge I.V. catheters should be inserted.
Your patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What's your priority? A. Ask the patient what happened, call the doctor, and cover the area with a water-soaked bed sheet. B. Obtain vital signs, call the doctor, and obtain emergency orders. C. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient's knees. D. Have the doctor called while you remain with the patient, flex the patient's knees, and cover the wound with sterile towels soaked in sterile saline solution.
D. Have the doctor called while you remain with the patient, flex the patient's knees, and cover the wound with sterile towels soaked in sterile saline solution. Call for help but stay with the patient. Tell the person who responds to notify the surgeon immediately. Lower the bed until it is flat or no steeper than 20 degrees. Have the patient bend his knees to reduce abdominal muscle tension. Soak sterile towels with sterile saline or use pre moistened sterile dressings.
A patient who underwent abdominal surgery now has a gaping incision due to delayed wound healing. Which method is correct when you irrigate a gaping abdominal incision with sterile normal saline solution, using a piston syringe? A. Rapidly instill a stream of irrigating solution into the wound. B. Apply a wet-to-dry dressing to the wound after the irrigation. C. Moisten the area around the wound with normal saline solution after the irrigation. D. Irrigate continuously until the solution becomes clear or all of the solution is used.
D. Irrigate continuously until the solution becomes clear or all of the solution is used. To wash away tissue debris and drainage effectively, irrigate the wound until the solution becomes clear of all the solution is used. Irrigation helps the wound to heal properly from the inside out; it helps prevent surface healing over an abscess pocket or infected tract. Continue to irrigate the wound until you have administered the prescribed amount of solution or until the solution returned is clear. Note the amount of solution administered. Remove and discard the catheter and syringe in the appropriate container.
Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection? A. Monitoring gastric pH to detect complications. B. Assessing for bowel sounds. C. Providing nutritional support. D. Monitoring for symptoms of hemorrhage.
D. Monitoring for symptoms of hemorrhage. The client should be monitored closely for signs and symptoms of hemorrhage, such as bright red blood in the nasogastric tube suction, tachycardia, or a drop in blood pressure. Identify signs and symptoms requiring medical evaluation such as persistent nausea and vomiting or abdominal fullness; weight loss; diarrhea; foul-smelling fatty or tarry stools; bloody or coffee-ground vomitus or presence of bile, fever. Instruct the patient to report changes in pain characteristics.
Which rationale supports explaining the placement of an esophageal tamponade tube in a client who is hemorrhaging? A. Allowing the client to help insert the tube B. Beginning teaching for home care C. Maintaining the client's level of anxiety and alertness D. Obtaining cooperation and reducing fear
D. Obtaining cooperation and reducing fear An esophageal tamponade tube would be inserted in critical situations. Typically, the client is fearful and highly anxious. The nurse, therefore, explains the placement to help obtain the client's cooperation and reduce his fear.
The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics? A. Early satiety B. Pain on eating C. Dull upper epigastric pain D. Pain on an empty stomach
D. Pain on an empty stomach Pain on an empty stomach is relieved by taking foods or antacids. The location of the disease can also be differentiated based on symptoms. The pain associated with duodenal ulcers improves after meals, while the pain associated with gastric ulcers generally intensifies after meals. The other symptoms are those of a gastric ulcer.
Annabelle is being discharged with a colostomy, and you're teaching her about colostomy care. Which statement correctly describes a healthy stoma? A. "At first, the stoma may bleed slightly when touched." B. "The stoma should appear dark and have a bluish hue." C. "A burning sensation under the stoma faceplate is normal." D. "The stoma should remain swollen away from the abdomen."
A. "At first, the stoma may bleed slightly when touched." For the first few days to a week, slight bleeding normally occurs when the stoma is touched because the surgical site is still new. She should report profuse bleeding immediately. A small amount of blood from the stoma itself is not unusual while it is healing.
The nurse is performing colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action? A. Notify the physician B. Stop the irrigation temporarily C. Increase the height of the irrigation D. Medicate for pain and resume the irrigation
B. Stop the irrigation temporarily. If cramping occurs during colostomy irrigation, the irrigation flow is stopped temporarily and the client is allowed to rest. Cramping may occur from an infusion that is too rapid or is causing too much pressure. Have the colostomy patient sit on or near the toilet for about 15 to 20 minutes so the initial colostomy returns can drain into the toilet. (If the patient is on bed rest, allow the colostomy to drain into the bedpan.)
Your patient with peritonitis is NPO and complaining of thirst. What is your priority? A. Increase the I.V. infusion rate. B. Use diversion activities. C. Provide frequent mouth care. D. Give ice chips every 15 minutes.
C. Provide frequent mouth care. Frequent mouth care helps relieve dry mouth. Maintain NPO with nasogastric or intestinal aspiration. This reduces hyperactivity of bowel and diarrhea losses. Observe skin or mucous membrane dryness, turgor. Note peripheral and sacral edema. Hypovolemia, fluid shifts, and nutritional deficits contribute to poor skin turgor, taut edematous tissues.
The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? A. Hypotension B. Bloody diarrhea C. Rebound tenderness D. A hemoglobin level of 12 mg/dL
C. Rebound tenderness Rebound tenderness may indicate peritonitis. During the physical exam, pertinent findings include fever and abdominal tenderness to palpation which usually is diffuse with wall rigidity in more septic presentations. Signs of peritonitis must be reported to the physician. It is important to conduct a thorough exam as certain thoracic or pelvic pathologies can mimic peritoneal irritation (empyema causing diaphragmatic irritation and cystitis/pyelonephritis causing peritoneum adjacent pain).
Polyethylene glycol-electrolyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following the administration of the solution. What action by the nurse is appropriate? A. Start an IV infusion B. Administer an enema C. Cancel the diagnostic test D. Explain that diarrhea is expected
D. Explain that diarrhea is expected. The solution GoLYTELY is a bowel evacuant used to prepare a client for a colonoscopy by cleansing the bowel. The solution is expected to cause mild diarrhea and will clear the bowel in 4 to 5 hours. Polyethylene glycol electrolyte (PEG) is essential for a wide range of bowel preparation, with advantages such as high security, reliable effect, no dehydration, and electrolyte disturbance.
A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action? A. Quickly insert the tube B. Notify the physician immediately C. Remove the tube and reinsert when the respiratory distress subsides D. Pull back on the tube and wait until the respiratory distress subsides
D. Pull back on the tube and wait until the respiratory distress subsides During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tubing advancement, and wait until the distress subsides. The most common indication for placement of a nasogastric tube is to decompress the stomach in the setting of distal obstruction. Less commonly, nasogastric tubes can be placed to administer medications or nutrition in patients who have a functional gastrointestinal tract but are unable to tolerate oral intake.
A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure: A. Decreases food absorption in the stomach. B. Heals the gastric mucosa. C. Halts stress reactions. D. Reduces the stimulus to acid secretions.
D. Reduces the stimulus to acid secretions. A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion. A vagotomy is a type of surgery that removes all or part of the vagus nerve. This nerve runs from the bottom of the brain, through the neck, and along the esophagus, stomach, and intestines in the gastrointestinal (GI) tract.
Your patient recently had abdominal surgery and tells you that he feels a popping sensation in his incision during a coughing spell, followed by severe pain. You anticipate an evisceration. Which supplies should you take to his room? A. A suture kit. B. Sterile water and a suture kit. C. Sterile water and sterile dressings. D. Sterile saline solution and sterile dressings.
D. Sterile saline solution and sterile dressings. Saline solution is isotonic, or close to body fluids in content, and is used along with sterile dressings to cover an eviscerated wound and keep it moist. If the wound shows signs of evisceration, the wound can be covered with a sterile saline dressing until the herniating organs can be reduced back into the abdomen. - A suture kit would be needed later during closure of the wound.
A nurse is preparing to remove a nasogastric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube? A. Exhale B. Inhale and exhale quickly C. Take and hold a deep breath D. Perform a Valsalva maneuver
take and hold a deep breath
