Saunders GI & perioperative practice questions

The home care nurse visits a client to perform a dressing change on a leg ulcer. The client has diabetes mellitus and a history of cardiac disease and is taking one aspirin daily in addition to other medications as prescribed. The client tells the nurse that dental surgery is scheduled and asks the nurse whether the aspirin should be discontinued. The nurse should most appropriately make which statement to the client?

"Dental surgery can safely be done usually 10 days after stopping the aspirin, depending on the health care provider's (HCP) preference."

A client has begun taking lansoprazole (Prevacid). The nurse monitors for which intended effect of this medication?

relief of nighttime heartburn

A client with peptic ulcer disease has a new prescription for propantheline (Pro-Banthine). Which client teaching instructions should the nurse reinforce?

take the med 30 minutes before meals

A client has a prescription for sucralfate (Carafate) 1 g by mouth 4 times daily. The nurse writes in the medication record to administer the medication at which time?

1 hr before meals and at bedtime

The client with a gastric ulcer has a prescription for sucralfate (Carafate) 1 g by mouth four times daily. The nurse should schedule the medication for which times?

1 hr before meals and at bedtime

The nurse has completed education about peptic ulcer disease (PUD) with the client. The nurse evaluates that learning has occurred when the client makes which statement? 1. "I will limit my intake of caffeine products." 2. "I will take ibuprofen (Motrin) for my headaches." 3. "I will drink more milk and limit spicy foods." 4. "I will join a gym and increase my exercise."

1. "I will limit my intake of caffeine products."

The pyloric sphincter regulates flow of food into the 1. small intestine. 2. stomach. 3. esophagus. 4. rectum

1. small intestine

The nurse is developing a plan of care for a client scheduled for surgery. The nurse should include which activity in the nursing care plan for the client on the day of surgery? 1. Avoid oral hygiene and rinsing with mouthwash. 2. Verify that the client has not eaten for the last 24 hours. 3. Have the client void immediately before going into surgery. 4. Report immediately any slight increase in blood pressure or pulse.

3. Have the client void immediately before going into surgery. R: The nurse would assist the client to void immediately before surgery so that the bladder will be empty. Oral hygiene is allowed, but the client should not swallow any water. The client usually has a restriction of food and fluids for 6 to 8 hours before surgery instead of 24 hours. A slight increase in blood pressure and pulse is common during the preoperative period and is usually the result of anxiety.

A client has been given a prescription for metoclopramide (Reglan) four times a day. Which is the optimal time to take this medication?

30 min before meals and at bedtime

Metoclopramide (Reglan) four times daily has been prescribed for a client with reflux esophagitis, and the nurse reinforces instructions to the client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication?

30 min before meals and at bedtime

The nursing instructor teaches the student nurses about intrinsic factor. The instructor evaluates that learning has occurred when the students make which response? 1. "Intrinsic factor is secreted by the chief cells of the stomach." 2. "Intrinsic factor is necessary for absorption of vitamin B6." 3. "Intrinsic factor aids in the secretion of mucus to protect the stomach." 4. "Intrinsic factor is necessary for absorption of vitamin B12."

4. "Intrinsic factor is necessary for absorption of vitamin B12."

An adult client with hepatic encephalopathy has a serum ammonia level of 120 mcg/dL and receives treatment with lactulose (Chronulac) syrup. The nurse determines that the client has the best response if the level changes to which after medication administration?

70

A client asks the nurse about which product should be taken for a headache. The client is taking lansoprazole (Prevacid) for long-term management of Zollinger-Ellison syndrome. The nurse determines that which medication would be the appropriate choice for this client?

Acetaminophen (Tylenol)

A client is admitted to the ambulatory surgery center for elective surgery. The nurse asks the client whether any food, fluid, or medication was taken today. Which medication, if taken by the client, should indicate to the nurse the need to contact the health care provider (HCP)?

An anticoagulant

The client has a PRN prescription for loperamide hydrochloride (Imodium). The nurse understands that this medication is used for which condition?

An episode of diarrhea

A client is recovering well 24 hours after cranial surgery but is fatigued. The neurosurgeon advances the client from NPO status to clear liquids. The nurse knows that which information is least reliable in determining the client's readiness to take in fluids?

Appetite

The nurse is developing a plan of care for a preoperative client who has a latex allergy. Which intervention should be included in the plan?

Apply a cloth barrier to the client's arm under a blood pressure cuff when taking the blood pressure.

A preoperative client has received a dose of scopolamine as prescribed by the anesthesiologist. The nurse should assess the client for which anticipated side effect of this medication?

Dry oral mucous membranes

The nurse is caring for a client who is postoperative following a pelvic exenteration and the health care provider changes the client's diet from NPO status to clear liquids. The nurse should check which priority item before administering the diet?

Bowel sounds

A client is admitted to a surgical unit postoperatively with a wound drain in place. Which actions should the nurse take in the care of the drain? Select all that apply.

Check the drain for patency. Observe for bright red bloody drainage. Maintain aseptic technique when emptying the drain.

A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment?

Checking the frequency and consistency of bowel movements

An older client recently has been taking cimetidine (Tagamet). The nurse should monitor the client for which most frequent central nervous system side effect of this medication?

Confusion

A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action?

Continue to monitor the drainage.

A client who has undergone radical neck dissection is experiencing problems with verbal communication related to postoperative hoarseness. The nurse should formulate which outcome as the most appropriate goal for this client problem?

Incorporates nonverbal forms of communication as needed

The client has a PRN prescription for ondansetron (Zofran). For which condition should this medication be administered to the postoperative client?

Nausea and vomiting

The client who frequently uses nonsteroidal antiinflammatory drugs (NSAIDs) has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which is noted?

Relief of epigastric pain

The nurse is providing discharge instructions to the client who has had a pneumonectomy and prepares a list of postoperative instructions for the client. Which intervention should the nurse include in the list?

Report any signs of respiratory infection to the health care provider (HCP).

A client arrives at the surgical unit after nasal surgery. The client has nasal packing in place. The nurse reviews the health care provider's prescriptions and understands that it is essential that the client be placed in which position to reduce swelling?

Semi-Fowler's position

A postoperative client requests medication for flatulence (gas pains). Which medication from the following PRN list should the nurse administer to this client?

Simethicone

A nurse is providing preoperative teaching to a client scheduled for a cholecystectomy. Which intervention would be of highest priority in the preoperative teaching plan?

Teaching coughing and deep breathing exercises

The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment finding indicates that the colostomy is beginning to function?

The passage of flatus

A postoperative client with a large abdominal wound requiring frequent dressing changes is starting to develop skin irritation in the area where the dressing tape is applied to the skin. The nurse determines that the client would benefit most from which measure?

The use of Montgomery straps

A client is scheduled for an intravenous pyelogram and has been instructed to take liquid magnesium citrate on the day before the scheduled procedure. The client asks the nurse about the administration procedure for this medication. Which instruction should the nurse provide to the client?

take the meds on ice

The nurse notes that a client is taking lansoprazole (Prevacid). On data collection the nurse asks which question to determine medication effectiveness?

are you experiencing any heartburn

A health care provider has written a prescription for ranitidine (Zantac) 300 mg once daily on the client's discharge medication list. The nurse plans to instruct the client to take the medication at which time?

at bedtime

The nurse reinforces medication instructions to a client with peptic ulcer disease. Which statement by the client indicates the best understanding of the medication therapy?

axid

613. A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). What intervention by the nurse will determine the effectiveness of treatment? a) Monitoring the leukocyte count for 2 days after the infusion b) Checking the frequency and consistency of bowel movements c) Checking serum liver enzyme levels before and after the infusion d) Carrying out a Hematest on gastric fluids after the infusion is completed

b) Checking the frequency and consistency of bowel movements Rationale: The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea.

620. A client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? a) Diarrhea b) Heartburn c) Flatulence d) Constipation

b) Heartburn Rationale: Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients.

619. A client who chronically uses nonsteroidal antiinflammatory drugs (NSAIDs) has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which finding is noted? a) Resolved diarrhea b) Relief of epigastric pain c) Decreased platelet count d) Decreased white blood cell count

b) Relief of epigastric pain Rationale: The client who chronically uses nonsteroidal antiinflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea can be a side effect of the medication but is not an intended effect.

The health care provider has written a prescription for ranitidine (Zantac), once daily. The nurse should schedule the medication for which time

bedtime

A client with portosystemic encephalopathy is receiving oral lactulose daily. The nurse should check which to determine medication effectiveness?

blood ammonia level

The nurse is administering a dose of prochlorperazine to a client for nausea and vomiting. The nurse tells the client to report which frequent side effect of this medication?

blurred vision

621. A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? a) "My ulcer will heal because these medications will kill the bacteria." b) "These medications are only taken when I have pain from my ulcer." c) "The medications will kill the bacteria and stop the acid production." d) "These medications will coat the ulcer and decrease the acid production in my stomach."

c) "The medications will kill the bacteria and stop the acid production." Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial medications and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.

614a. A client has a PRN prescription for loperamide hydrochloride (Imodium). For which condition should the nurse administer this medication? a) Constipation b) Abdominal pain c) An episode of diarrhea d) Hematest-positive nasogastric tube drainage

c) An episode of diarrhea Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy.

617. An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication? a) Tremors b) Dizziness c) Confusion d) Hallucinations

c) Confusion Rationale: Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

A client with hepatic encephalopathy is receiving lactulose (Cephulac). The nurse determines that the medication is effective if which finding is observed?

the client was oriented to person only can now state name

616. A client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? a) Weight loss b) Relief of heartburn c) Reduction of steatorrhea d) Absence of abdominal pain

c) Reduction of steatorrhea Rationale: Pancrelipase (Pancrease, Creon) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.

618. A client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse should schedule the medication for which times? a) With meals and at bedtime b) Every 6 hours around the clock c) One hour after meals and at bedtime d) One hour before meals and at bedtime

d) One hour before meals and at bedtime Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation.

A client with peptic ulcer disease has been prescribed misoprostol (Cytotec) and sucralfate (Carafate). The nurse reinforces teaching the client that these two medications will work primarily for which reason?

the meds protect the gastric mucosa

A long-term care nurse is caring for an older client taking cimetidine (Tagamet). The nurse observes this client frequently for which most common central nervous system (CNS) side effect of this medication?

confusion

615. A client has a PRN prescription for ondansetron (Zofran). For which condition should the nurse administer this medication to the postoperative client? a) Paralytic ileus b) Incisional pain c) Urinary retention d) Nausea and vomiting

d) Nausea and vomiting Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy.

622. A client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition? a) Intestinal obstruction b) Peptic ulcer with melena c) Diverticulitis with perforation d) Vomiting following cancer chemotherapy

d) Vomiting following cancer chemotherapy Rationale: Metoclopramide is a gastrointestinal stimulant and antiemetic. Because it is a gastrointestinal stimulant, it is contraindicated with gastrointestinal obstruction, hemorrhage, or perforation. It is used in the treatment of emesis after surgery, chemotherapy, and radiation.

The nurse is preparing to reinforce instructions to the client who has been given a prescription for diphenoxylate with atropine (Lomotil). Which instructions should the nurse include?

do not exceed the recommended dose because it can be habit forming

The nurse is preparing to reinforce instructions to the client who has been given a prescription for diphenoxylate with atropine (Lomotil). Which instructions should the nurse include?

full glass of liquid, followed by a second glass of liquid

The client has been taking omeprazole (Prilosec) for 4 weeks. The nurse evaluates that the client is receiving an optimal intended effect of the medication if the client reports the absence of which symptom

heartburn

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen

the meds will kill the bacteria and stop acid production

The nurse has reinforced instructions to a client who has been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further teaching?

this med should only be taken with water

A client is taking lansoprazole (Prevacid) for the chronic management of Zollinger-Ellison syndrome. If prescribed, which medication would be appropriate for the client if needed for a headache?

tylenol

The client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition?

vomiting following cancer chemo

A client uses the alternative therapy of cascara sagrada, known as Californian buckthorn, for ongoing management of chronic constipation. The nurse monitors the client's laboratory results for which electrolyte imbalance specifically related to long-term use of this medication?

hypokalemia

Sucralfate (Carafate) 1 g four times daily has been prescribed for a client with a diagnosis of gastric ulcer, and the nurse reinforces instructions to the client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication?

i need to take the meds 1 hour before my meals and at bedtime

Psyllium (Metamucil) is prescribed for a client with a cardiac disorder to facilitate defecation and prevent straining with bowel movements. The nurse reinforces instructions to a client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication?

i should mix the medication with custard

The nurse is monitoring the status of a postoperative client. The nurse would become most concerned with which sign that could indicate an evolving complication? 1. Increasing restlessness 2. A pulse of 86 beats/minute 3. Blood pressure of 110/70 mm Hg 4. Hypoactive bowel sounds in all four quadrants

1. Increasing restlessness R: Increasing restlessness is a sign that requires continuous and close monitoring because it could indicate a potential complication, such as hemorrhage, shock, or pulmonary embolism. A blood pressure of 110/70 mm Hg with a pulse of 86 beats/minute is within normal limits. Hypoactive bowel sounds heard in all four quadrants are a normal occurrence.

A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply. 1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) 5. Esomeprazole (Nexium) 6. Lansoprazole (Prevacid)

1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) Rationale: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors.

The client receives misoprostol (Cytotec) for treatment of peptic ulcer disease (PUD). The client asks the nurse why he is receiving this medication. What is the best response by the nurse? 1. "It dissolves into a gel and sticks to your ulcer." 2. "It increases mucus production in your stomach." 3. "It inhibits bacterial growth." 4. "It neutralizes stomach acid."

2. "It increases mucus production in your stomach."

The nurse completes medication education for the client receiving sucralfate (Carafate). The nurse evaluates that learning has occurred when the client makes which statement? 1. "This works by inhibiting bacterial growth in my stomach." 2. "This works by dissolving into a jelly and sticking to my ulcer." 3. "This works by decreasing the amount of acid in my stomach." 4. "This works by neutralizing the acid in my stomach."

2. "This works by dissolving into a jelly and sticking to my ulcer."

What is the correct administration technique for sucralfate (Carafate)? 1. Administer it after meals. 2. Administer it prior to meals. 3. Administer the drug once daily. 4. Administer it with milk.

2. Administer it prior to meals

The client has gastroesophageal reflux disease (GERD) and has been receiving medication treatment for many years. What priority assessment findings associated with the medication must the nurse report to the physician? 1. Vomiting and mild upper mid-epigastric pain 2. Anemia, fatigue, and weakness 3. Hypotension and tachycardia 4. Diarrhea and soft stools

2. Anemia, fatigue, and weakness

A client is admitted for treatment of a duodenal ulcer. What will the nurse's admission assessment likely reveal? 1. Nausea and lower right quadrant abdominal pain 2. Burning pain several hours after eating a meal 3. Anorexia and weight loss 4. Low back pain radiating down the left leg

2. Burning pain several hours after eating a meal

The physician has ordered combination therapy for the client with peptic ulcer disease (PUD). The nurse plans to do medication education. What will the best plan by the nurse include? 1. Combination therapy has the best outcomes when antibiotics are used with antacids. 2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors. 3. The use of sucralfate (Carafate) along with antibiotics is the best combination therapy for peptic ulcer disease (PUD). 4. Various antibiotics are used to eradicate the bacteria that are responsible for the development of peptic ulcer disease (PUD).

2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors.

A client who has undergone preadmission testing has had blood drawn for serum laboratory studies, including a complete blood count, coagulation studies, and electrolytes and creatinine levels. Which laboratory result should be reported to the surgeon's office by the nurse, knowing that it could cause surgery to be postponed? 1. Sodium, 141 mEq/L 2. Hemoglobin, 8.0 g/dL 3. Platelets, 210,000/mm3 4. Serum creatinine, 0.8 mg/dL

2. Hemoglobin, 8.0 g/dL R: Routine screening tests include a complete blood count, serum electrolyte analysis, coagulation studies, and a serum creatinine test. The complete blood count includes the hemoglobin analysis. All these values are within normal range except for hemoglobin. If a client has a low hemoglobin level, the surgery likely could be postponed by the surgeon.

The physician orders misoprostol (Cytotec) for the female client with peptic ulcer disease (PUD). What is a priority question for the nurse to ask the client prior to administration of this medication? 1. "Do you plan on becoming pregnant?" 2. "Are you sexually active?" 3. "Are you pregnant?" 4. "Are your menstrual cycles irregular?"

3. "Are you pregnant?"

The physician has ordered bismuth (Pepto-Bismol) for the client with a peptic ulcer who is colonized with H. Pylori. The client asks the nurse why he is receiving this drug. What is the best response by the nurse? Select all that apply. 1. "Bismuth (Pepto-Bismol) increases stomach acid to help kill bacteria." 2. "Bismuth (Pepto-Bismol) helps prevent the side effects of antibiotics." 3. "Bismuth (Pepto-Bismol) is effective for inhibiting bacterial growth." 4. "Bismuth (Pepto-Bismol) keeps bacteria from sticking in your stomach." 5. "Bismuth (Pepto-Bismol) helps relieve ulcer-related constipation."

3. "Bismuth (Pepto-Bismol) is effective for inhibiting bacterial growth." 4. "Bismuth (Pepto-Bismol) keeps bacteria from sticking in your stomach."

A preoperative client expresses anxiety to the nurse about upcoming surgery. Which response by the nurse is most likely to stimulate further discussion between the client and the nurse? 1. "If it's any help, everyone is nervous before surgery." 2. "I will be happy to explain the entire surgical procedure to you." 3. "Can you share with me what you've been told about your surgery?" 4. "Let me tell you about the care you'll receive after surgery and the amount of pain you can anticipate."

3. "Can you share with me what you've been told about your surgery?" Explanations should begin with the information that the client knows. By providing the client with individualized explanations of care and procedures, the nurse can assist the client in handling anxiety and fear for a smooth preoperative experience. Clients who are calm and emotionally prepared for surgery withstand anesthesia better and experience fewer postoperative complications. Option 1 does not focus on the client's anxiety. Explaining the entire surgical procedure may increase the client's anxiety. Option 4 avoids the client's anxiety and is focuses on postoperative care.

The nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of arthritis and has been taking acetylsalicylic acid (aspirin). The nurse determines that the client needs additional teaching if the client makes which statement? 1. "Aspirin can cause bleeding after surgery." 2. "Aspirin can cause my ability to clot blood to be abnormal." 3. "I need to continue to take the aspirin until the day of surgery." 4. "I need to check with my health care provider about the need to stop the aspirin before the scheduled surgery."

3. "I need to continue to take the aspirin until the day of surgery." R: Anticoagulants alter normal clotting factors and increase the risk of bleeding after surgery. Aspirin has properties that can alter the clotting mechanism and should be discontinued at least 48 hours before surgery. However, the client should always check with his or her health care provider regarding when to stop taking the aspirin when a surgical procedure is scheduled. Options 1, 2, and 4 are accurate client statements

The nurse planning medication administration instruction for a client receiving antacids should consider including which information? 1. Antacids can be safely administered with H2-receptor medications. 2. Antacids can be safely administered with antibiotics. 3. Administer antacids at least 2 hours before other oral medications. 4. Lay down for 30 minutes after taking antacids.

3. Administer antacids at least 2 hours before other oral medications.

An elderly client comes to the emergency department with his wife. He has a history of peptic ulcer disease (PUD), and is currently experiencing confusion and severe headaches. What does the best plan by the nurse include? 1. Ask the client if he has experienced any head injuries recently. 2. Obtain a complete blood count (CBC), chemistry profile, and urine drug screen. 3. Ask the client's wife for a list of medications that the client has taken. 4. Obtain a magnetic resonance imaging (MRI) exam to assess if the client has experienced a stroke.

3. Ask the client's wife for a list of medications that the client has taken

The nurse is conducting preoperative teaching with a client about the use of an incentive spirometer. The nurse should include which piece of information in discussions with the client? 1. Inhale as rapidly as possible. 2. Keep a loose seal between the lips and the mouthpiece. 3. After maximum inspiration, hold the breath for 15 seconds and exhale. 4. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees.

4. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees. R: For optimal lung expansion with the incentive spirometer, the client should assume the semi-Fowler's or high Fowler's position. The mouthpiece should be covered completely and tightly while the client inhales slowly, with a constant flow through the unit. The breath should be held for 5 seconds before exhaling slowly.

A client has arrived in the clinic complaining of dyspepsia and pain that occurs about 90 minutes after eating. The client also reports that the pain got worse this afternoon about 3 hours after eating a large bowl of spaghetti with tomato sauce. Laboratory tests reveal the presence of Helicobacter pylori (H. pylori). The nurse anticipates that the health care provider will prescribe which medications? Select all that apply.

Esomeprazole (Nexium) Metronidazole (Flagyl) Clarithromycin (Biaxin)

The nurse in a surgical unit receives a postoperative client from the postanesthesia care unit. After the initial assessment of the client, the nurse should plan to continue with postoperative assessment activities how often?

Every 15 minutes for the first hour, every 30 minutes for 2 hours, every hour for 4 hours, and then every 4 hours as needed

The nurse is collecting data from a client who is taking pantoprazole (Protonix). The nurse determines that the medication is effective if the client states relief of which symptom

heartburn

624. The nurse has given instructions to a client who has just been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? a) "I will continue taking vitamin supplements." b) "This medication will help lower my cholesterol." c) "This medication should only be taken with water." d) "A high-fiber diet is important while taking this medication."

c) "This medication should only be taken with water." Rationale: Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption.

The nurse receives a telephone call from the postanesthesia care unit stating that a client is being transferred to the surgical unit. The nurse plans to take which action first on arrival of the client? 1. Assess the patency of the airway. 2. Check tubes or drains for patency. 3. Check the dressing to assess for bleeding. 4. Assess the vital signs to compare with preoperative measurements.

1. Assess the patency of the airway. R: The first action of the nurse is to assess the patency of the airway and respiratory function. If the airway is not patent, the nurse must take immediate measures for the survival of the client. The nurse then takes vital signs followed by checking the dressing and the tubes or drains. The other nursing actions should be performed after a patent airway has been established.

A client comes to the clinic with report of intermittent epigastric pain that is associated with meals. The nurse would review the client's medical record and assess for the presence of which risk factors for peptic ulcer disease (PUD)? Select all that apply. 1. The client reports that his mother and grandfather both had ulcers. 2. The client has type AB blood. 3. The client reports drinking several cups of coffee every morning. 4. The client reports mild to moderate job and family stress. 5. The client tested positive for influenza A

1. The client reports that his mother and grandfather both had ulcers. 3. The client reports drinking several cups of coffee every morning.

The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the next hour? 1. Urinary output of 20 mL/hour 2. Temperature of 37.6 ° C (99.6 ° F) 3. Blood pressure of 100/70 mm Hg 4. Serous drainage on the surgical dressing

1. Urinary output of 20 mL/hour R: Urine output should be maintained at a minimum of 30 mL/hour for an adult. An output of less than 30 mL for each of 2 consecutive hours should be reported to the health care provider. A temperature higher than 37.7 ° C (100 ° F) or lower than 36.1 ° C (97 ° F) and a falling systolic blood pressure, lower than 90 mm Hg, are usually considered reportable immediately. The client's preoperative or baseline blood pressure is used to make informed postoperative comparisons. Moderate or light serous drainage from the surgical site is considered normal.

The nurse is aware that antacids containing magnesium and aluminum can cause 1. diarrhea. 2. abdominal pain. 3. constipation. 4. indigestion.

1. diarrhea.

The nurse has completed medication education for the client who takes psyllium mucilloid (Metamucil). The nurse recognizes that additional teaching is indicated when the client makes which statement? 1."I don't need to drink fluids while I take this medication." 2. "My cholesterol level could be reduced somewhat with this medication." 3. "This medication is more natural than other laxatives." 4."This medication may take several days to work."

1."I don't need to drink fluids while I take this medication."

A client has been prescribed ranitidine (Zantac). The nurse plans to include which information in the teaching plan for this client? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Question options: 1.You should experience symptom relief almost immediately after taking this medication 2.This medication will decrease the acid production in your stomach, but not completely eliminate acid. 3. Take this medication before or after your meal. 4.This drug will not work as well if you continue smoking.

1.You should experience symptom relief almost immediately after taking this medication 2.This medication will decrease the acid production in your stomach, but not completely eliminate acid. 3.Take this medication before or after your meal. 4.This drug will not work as well if you continue smoking.

A client has been prescribed sulfasalazine (Azulfidine) for treatment of ulcerative colitis. Which nursing assessment question is essential? 1. "How long have you had ulcerative colitis?" 2. "What are you allergic to?" 3. "Are you lactose intolerant?" 4. "Do you have to stand in one place for long periods of time at your work?"

2. "What are you allergic to?"

Pancreatic enzyme replacement is most commonly used for acute pancreatitis. 1. True 2. False

2. False

A client has developed nausea and vomiting. What is the nurse's primary treatment? 1. Replacement of fluids 2. Identifying and eliminating the cause 3. Encouraging the client to lie still 4. Providing the client with soft foods

2. Identifying and eliminating the cause

The nurse assesses a client's surgical incision for signs of infection. Which finding by the nurse would be interpreted as a normal finding at the surgical site? 1. Red, hard skin 2. Serous drainage 3. Purulent drainage 4. Warm, tender skin

2. Serous drainage R: Serous drainage is an expected finding at a surgical site. The other options indicate signs of wound infection. Signs and symptoms of infection include warm, red, and tender skin around the incision. Wound infection usually appears 3 to 6 days after surgery. The client also may have a fever and chills. Purulent material may exit from drains or from separated wound edges. Infection may be caused by poor aseptic technique or a contaminated wound before surgical exploration; existing client conditions such as diabetes mellitus or immunocompromise may place the client at risk.

A client has been prescribed ranitidine (Zantac). The nurse plans to include which information in the teaching plan for this client? Select all that apply. 1. You should experience symptom relief in 10 to 15 minutes after taking this drug. 2. Take this medication after your meal. 3. Take this medication first thing in the morning, before breakfast. 4. This drug will not work as well if you continue smoking. 5. If you experience confusion, discontinue the drug and call for an appointment.

2. Take this medication after your meal. 4. This drug will not work as well if you continue smoking

It is suspected that a client has developed peptic ulcer disease (PUD). Which information should the nurse provide this client regarding projected course of treatment? Select all that apply. 1. You will be started on an antibiotic. 2. You will be tested for the presence of H. pylori. 3. You may be directed to take Pepto-Bismol along with your other medications. 4. You should plan on taking medication for 4 to 8 weeks. 5. There are some lifestyle changes you can take to make therapy more successful.

2. You will be tested for the presence of H. pylori. 3. You may be directed to take Pepto-Bismol along with your other medications. 4. You should plan on taking medication for 4 to 8 weeks. 5. There are some lifestyle changes you can take to make therapy more successful.

A client has been prescribed prochlorperazine (Compazine) for nausea. Possible adverse effects would include 1. diarrhea. 2. dry mouth. 3. hypertension. 4. bradycardia.

2. dry mouth

The mechanism of action of proton pump inhibitors is to 1. neutralize acid. 2. reduce acid secretion in the stomach. 3. block H2 receptors in the stomach. 4. decrease infection.

2. reduce acid secretion in the stomach.

A patient is prescribed finasteride (Proscar). The nurse knows that the following is important to remember about this medication: (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1.This medication may cause significant hypotension since it is commonly given for hypertension. 2.This medication should not be taken or handled by those that are pregnant. 3.While on this medication the patient cannot donate blood. 4.This medication may cause premature balding in males.

2.This medication should not be taken or handled by those that are pregnant. 3.While on this medication the patient cannot donate blood.

A client who was diagnosed with clostridium difficile calls the clinic and says, "I'm still having diarrhea so I started taking an over-the-counter medication to stop it." How should the nurse respond? 1. "Which antidiarrheal are you taking?" 2. "How many doses have you taken?" 3. "Stop taking the medicine and come to the clinic." 4. "Is it stopping your diarrhea?"

3. "Stop taking the medicine and come to the clinic."

The client receives H2-receptor antagonists for treatment of peptic ulcer disease (PUD). Which assessment finding should be reported immediately to the physician? 1. The client reports he is constipated. 2. The client reports pain after 24 hours of treatment. 3. The client reports episodes of melana. 4. The client reports he took the antacid Tums with his H2-receptor antagonist

3. The client reports episodes of melana

A client has been prescribed aluminum hydroxide (AlternaGEL) for the treatment of heartburn. Which information should the nurse plan to teach this client? Select all that apply. 1. You should expect this medication to take up to two days to start taking effect. 2. Take this medication with a glass of milk. 3. You may notice constipation as an effect of this drug. 4. Take this medication at least 2 hours before or after any other medication you are taking. 5. This medication will reduce the acid your stomach produces.

3. You may notice constipation as an effect of this drug. 4. Take this medication at least 2 hours before or after any other medication you are taking.

Peptic ulcer disease is treated primarily with 1. pharmacotherapy. 2. exercise. 3. a combination of lifestyle changes and pharmacotherapy. 4. diet.

3. a combination of lifestyle changes and pharmacotherapy

The primary goal in treatment of gastroesophageal reflux disease is to 1. promote ulcer healing. 2. prevent infection. 3. reduce gastric acid secretions. 4. decrease stomach pain.

3. reduce gastric acid secretions.

The client takes diphenoxylate with atropine (Lomotil) for diarrhea. The client asks the nurse why he does not experience pain relief since this drug is an opioid. What is the best response by the nurse? 1. "This drug is not an opioid; did your doctor tell you that?" 2. "You would really have to take a lot to experience pain relief." 3. "It does provide some relief from the pain associated with diarrhea." 4. "Because this opioid does not have analgesic properties."

4. "Because this opioid does not have analgesic properties."

The client takes a stool softener on a regular basis and now reports a change in bowel patterns. Which assessment finding is the priority for the nurse to discuss with the physician? 1. Stools that are smaller in size 2. An increase in bowel frequency 3. A decrease in bowel frequency 4. Cramping with each stool passed

4. Cramping with each stool passed

The nurse teaches young females in college about the importance of vitamins for anyone planning on becoming pregnant. Which vitamin does the nurse include as being most essential in the prevention of neural tube defects in a fetus? 1. Thiamine 2. Niacin 3. Riboflavin 4. Folic acid

4. Folic acid

A client with a perforated gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form because of sedation from opioid analgesics that have been administered. The nurse should take which most appropriate action in the care of this client? 1. Obtain a court order for the surgery. 2. Have the charge nurse sign the informed consent immediately. 3. Send the client to surgery without the consent form being signed. 4. Obtain a telephone consent from a family member, following agency policy.

4. Obtain a telephone consent from a family member, following agency policy. R: Every effort should be made to obtain permission from a responsible family member to perform surgery if the client is unable to sign the consent form. A telephone consent must be witnessed by two persons who hear the family member's oral consent. The two witnesses then sign the consent with the name of the family member, noting that an oral consent was obtained. Consent is not informed if it is obtained from a client who is confused, unconscious, mentally incompetent, or under the influence of sedatives. In an emergency, a client may be unable to sign and family members may not be available. In this situation, a health care provider is permitted legally to perform surgery without consent, but in this case it is not an emergency. Options 1 and 3 are not appropriate in this situation. Also, agency policies regarding informed consent should always be followed.

An erosion of the mucosal layer of the stomach or duodenum describes a 1. diverticulum. 2. Crohn's lesion. 3. hiatal hernia. 4. Peptic ulcer.

4. Peptic ulcer

The mechanism of action of the antidiarrheal atropine (Lomotil) is to 1. promote stool passage. 2. block dopamine receptors in the brain. 3. increase stool formation. 4. slow peristalsis.

4. slow peristalsis.

The nurse is aware that efficient absorption of calcium is assisted by 1. intrinsic factor. 2. coenzymes. 3. phosphorus. 4. vitamin D.

4. vitamin D.

The nurse knows that an important thing to remember about magnesium hydroxide (Milk of Magnesia) is that: 1.This medication may cause constipation. 2.This medication may cause a decrease in serum magnesium levels. 3. This medication should be used avoided in patients with severe renal failure. 4.This medication takes several days to work effectively.

This medication should be used avoided in patients with severe renal failure.

The nurse is assigned to care for a client with a diagnosis of hepatic encephalopathy. Which prescribed medication does the nurse anticipate administering?

lactulose

A client with peptic ulcer disease has been prescribed to take cimetidine (Tagamet). How does this medication primarily work?A client with peptic ulcer disease has been prescribed to take cimetidine (Tagamet). How does this medication primarily work?

med inhibits histamine action

A client has just taken a dose of trimethobenzamide (Tigan). The nurse determines that the medication has been effective if the client reports which outcome?

n&v has been relieved

Atropine sulfate is prescribed for a client with gastrointestinal hypermotility, and the nurse reviews the client's record before administering the medication. Which finding, if noted on the client's record, indicates the need to contact the health care provider before administering the medication?

narrow-angle glaucoma

A client with a diagnosis of gastric ulcer has a prescription for oral sucralfate (Carafate) four times daily. At which time should the nurse plan to administer the medication?

one hour before meals and at bedtime

A client is taking docusate sodium (Colace). The nurse monitors which result to determine whether the client is having a therapeutic effect from this medication?

reg bowel movements

A client who has had abdominal surgery complains of feeling as though "something gave way" in the incisional site. The nurse removes the dressing and notes the presence of a loop of bowel protruding through the incision. Which nursing interventions should the nurse take? Select all that apply. 1. Contact the surgeon. 2. Instruct the client to remain quiet. 3. Prepare the client for wound closure. 4. Document the findings and actions taken 5. Place a sterile saline dressing and ice packs over the wound. 6. Place the client in a supine position without a pillow under the head.

1. Contact the surgeon. 2. Instruct the client to remain quiet. 3. Prepare the client for wound closure. 4. Document the findings and actions taken R: Wound dehiscence is the separation of the wound edges. Wound evisceration is protrusion of the internal organs through an incision. If wound dehiscence or evisceration occurs, the nurse should call for help, stay with the client, and ask another nurse to contact the surgeon and obtain needed supplies to care for the client. The nurse places the client in a low Fowler's position, and the client is kept quiet, and instructed not to cough. Protruding organs are covered with a sterile saline dressing. Ice is not applied because of its vasoconstrictive effect. The treatment for evisceration is usually immediate wound closure under local or general anesthesia. The nurse also documents the findings and actions taken.

The nurse designs a plan of care for the client with peptic ulcer disease (PUD) who is taking omeprazole (Prilosec) for the management of his illness. What will the best plan by the nurse include? Select all that apply. 1. Omeprazole (Prilosec) should not be crushed or chewed. 2. Omeprazole (Prilosec) is best taken with yogurt. 3. Omeprazole (Prilosec) is recommended for long-term treatment of peptic ulcer disease (PUD). 4. Omeprazole (Prilosec) should be administered before meals. 5. Omeprazole (Prilosec) should be administered after meals.

1. Omeprazole (Prilosec) should not be crushed or chewed 4. Omeprazole (Prilosec) should be administered before meals.

A postoperative client asks the nurse why it is so important to deep-breathe and cough after surgery. When formulating a response, the nurse incorporates the understanding that retained pulmonary secretions in a postoperative client can lead to which condition? 1. Pneumonia 2. Hypoxemia 3. Fluid imbalance 4. Pulmonary embolism

1. Pneumonia R: Postoperative respiratory problems are atelectasis, pneumonia, and pulmonary emboli. Pneumonia is the inflammation of lung tissue that causes productive cough, dyspnea, and lung crackles and can be caused by retained pulmonary secretions. Hypoxemia is an inadequate concentration of oxygen in arterial blood. Fluid imbalance can be a deficit or excess related to fluid loss or overload. Pulmonary embolus occurs as a result of a blockage of the pulmonary artery that disrupts blood flow to one or more lobes of the lung; this is usually due to clot formation.

The nurse is reviewing a health care provider's (HCP's) prescription sheet for a preoperative client that states that the client must be NPO after midnight. The nurse would telephone the HCP to clarify that which medication should be given to the client and not withheld? 1. Prednisone 2. Ferrous sulfate 3. Cyclobenzaprine (Flexeril) 4. Conjugated estrogen (Premarin)

1. Prednisone R: Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which reduces the ability of the body to withstand stress. When stress is severe, corticosteroids are essential to life. Before and during surgery, dosages may be increased temporarily. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia. Cyclobenzaprine (Flexeril) is a skeletal muscle relaxant. Conjugated estrogen (Premarin) is an estrogen used for hormone replacement therapy in postmenopausal women. These last three medications may be withheld before surgery without undue effects on the client.

The client receives esomeprazole (Nexium). He asks the nurse why that little purple pill is better than his cimetidine (Tagamet). What is the best response by the nurse? 1. "It is about the same, but a lot cheaper than your cimetidine (Tagamet)." 2. "It decreases acid in your stomach, better than cimetidine (Tagamet)." 3. "It is about the same, but has fewer side effects than your cimetidine (Tagamet)." 4. "It is not as effective as cimetidine (Tagamet), but kills bacteria better."

2. "It decreases acid in your stomach, better than cimetidine (Tagamet)."