FINAL REVEIW

A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including metronidazole, omeprazole, and clarithromycin. Which statement by the client indicates the best understanding of the medication regimen?

"The medications will kill the bacteria and stop the acid production."

WBC range

5,000-10,000

The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. Which action by the client demonstrates that the client has understood the recommended dietary changes?

Avoiding chocolate and coffee.

...

Chocolate, tea, cola, and caffeine lower esophageal sphincter pressure, thereby increasing reflux. Clients do not need to eliminate spicy foods unless such foods bother them. Foods with seeds are restricted in diverticulosis. Steamed foods are encouraged to retain vitamins and decrease fat intake.

.....

Clients with duodenal ulcers usually secrete an excess amount of hydrochloric acid. Clients with chronic atrophic gastritis secrete little or no acid. Clients with gastric cancer secrete little or no acid. Clients with pernicious anemia secrete no acid under basal conditions or after stimulation.

....

Clinical manifestations of chronic gastritis include belching, early satiety, and a sour taste in the mouth. Hiccups and hematemesis are symptoms of acute gastritis.

Which of the following is the diagnostic of choice if the suspected diagnosis is diverticulitis?

Computed tomography scan

The nurse is preparing to educate a group of students on a gastrointestinal assessment. Which common condition will the nurse assess for in the client with gastrointestinal disorder?

Dyspepsia (pain in the upper abdomen)

A client has been taking famotidine at home. What teaching should the nurse include with the client?

Famotidine will inhibit gastric acid secretions.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

Hemoglobin and hematocrit

A patient diagnosed with IBS is advised to eat a diet that is:

High in fiber.

both UC and chrohn's disease are ..

Inflammatory

....

Tests of serum electrolytes may indicate low levels of sodium, potassium, and chloride. Metabolic alkalosis is evidenced by arterial blood gas results. A complete blood count (CBC) shows an increased WBC count in instances of infection. The hematocrit level is elevated if dehydration develops.

The nurse is caring for a geriatric client experiencing diarrhea. When teaching about the site in the body where water and electrolytes are absorbed, the nurse is most correct to instruct on which location?

The large intestine

Which statement correctly identifies a difference between duodenal and gastric ulcers?

Vomiting is uncommon in clients with duodenal ulcers.

screening for rectal cancer

colonoscopy

pain =

priority

The nurse instructs a client with a peptic ulcer on modifications to make to their diet. Which statement indicates to the nurse that teaching has been effective?

"I will stop drinking decaffeinated coffee."

A nurse is providing education for a client diagnosed with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The client has recently been prescribed misoprostol. Which information will the nurse include in client education about the drug? Select all that apply.

-It protects the stomach's lining -It should be taken with food

A client has been diagnosed with chronic gastritis. The nurse knows that which of the following symptoms are indicative of gastritis? Select all that apply.

Belching Early satiety Sour taste in the mouth

A 60-year-old woman had a right hemicolectomy and the creation of an ileostomy 4 days ago, and she has been admitted to the postsurgical unit for a 7-day recovery. The nurse's assessment at the beginning of the shift has focused on common postsurgical complications and the patient's stoma and output. At this stage in the patient's recovery, what type of output should the nurse expect from the patient's ileostomy?

Continuous output of liquid effluent

A nurse is caring for a client who was admitted with pain, tenderness, and rigidity of the upper right abdomen, suggesting a gall bladder issue. The client has also been experiencing nausea and vomiting for the past 3 days. The admitting service is planning for tests to be conducted in the morning.

DiagnosticImplications for Testing Laboratory Assessments Cholesterol is elevated in biliary obstruction .Ultrasonography It is used to visualize calculi in the gallbladder. Cholescintigraphy The radioactive dye allows for visualization of the biliary tract.

.....

Explanation: A surgical site wound infection is a potential complication that may occur in a client following an appendectomy. The distal portion of the incision is no longer well-approximated and has yellow drainage, signaling that the wound has become infected. Additionally, the bulb drain contains pus. The client has an oral temperature of 101.2°F (38.4°C), a sign of infection, which requires follow-up. The heart rate (102 beats/min) and respiratory rate (22 breaths/min) are also elevated, most likely secondary to fever and infection, and require further assessment. The white blood count of 12.9 x 103 cells/mm3 (12.9 x 109/l) is elevated indicating the client has an infection. A blood glucose level of 130 mg/dl (7.21 mmol/l) is elevated and requires follow-up because an elevated blood glucose level impairs wound healing. The client's lungs are clear and oxygen saturation is within normal limits, suggesting that the client does not have a respiratory infection. The client most likely does not have peritonitis, because the client only reports incisional pain, not abdominal pain. The client with peritonitis would most likely have an absence of bowel sounds and a rigid boardlike abdomen.

need for further teaching in COPD pt

I will take my bronchodilator after meals (should be taken before meals)

.....

Laboratory assessments such as cholesterol levels are used to identify the high levels of cholesterol that contribute to the cholesterol stones. Acidosis (low pH) is not used to diagnosis gall bladder conditions but to identify acid-base imbalances. Potassium is an electrolyte and is not elevated or decreased with the presence of gallstones. An ultrasound or sonography is a high-frequency sound used to produce images of the soft tissue of the gallbladder. Ultrasound can identify a mass, but it does not provide the information needed to determine whether the mass is benign or malignant. The ultrasound does not require sedation; the client is usually awake during the procedure. Cholescintigraphy has been used successfully to diagnosis acute cholecystitis or blockage of a bile duct. In this procedure, a radioactive agent is administered intravenously and then the biliary tract is scanned and images of the gallbladder and biliary tract are obtained. This procedure is more expensive, takes longer to perform and exposes the client to radiation. This procedure does not involve x-rays or high-frequency sound.

Misoprostol

Misoprostol (a mucosal protective drug) has similar effects as H2 blockers in preventing ulcers when given in full doses. It should be taken with food. NSAIDs decrease prostaglandin production and predispose the client to peptic ulceration. Misoprostol does not reduce gastric acidity, improve emptying of the stomach, or increase lower esophageal sphincter pressure.

...

Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity. It is an abdominal emergency and requires immediate surgery. Signs and symptoms of perforation include vomiting, a tender and rigid board-like abdomen, hypotension, and upper abdominal pain that refers to the right shoulder. A pulsating mass in the left abdominal region would occur with an abdominal aortic aneurysm.

....

The nurse assesses for faintness or dizziness and nausea, which may precede or accompany bleeding. It is important to monitor vital signs frequently and to evaluate for tachycardia, hypotension, and tachypnea. Other nursing interventions include monitoring the hemoglobin and hematocrit, testing the stool for gross or occult blood, and recording hourly urinary output to detect anuria or oliguria (absence of or decreased urine production). If bleeding cannot be managed by the measures described, other treatment modalities such as endoscopy may be used to halt bleeding and avoid surgical intervention. There is debate regarding how soon endoscopy should be performed. Some clinicians believe endoscopy should be performed within the first 24 hours after hemorrhaging has ceased. Others believe endoscopy may be performed during acute bleeding, as long as the esophageal or gastric area can be visualized (blood may decrease visibility). An upper GI is less accurate than endoscopy and would not reveal a bleed. Arteriography is an invasive study associated with life-threatening complications and would not be used for an initial evaluation.

A client with a recent history of intermittent bleeding is undergoing capsule endoscopy to determine the source of the bleeding. When explaining this diagnostic test to the client, what advantage should the nurse describe?

The test is noninvasive.

A client with a nasogastric tube set to low intermittent suction is receiving D51/2NS at 100 mL/hr. The nurse has identified a nursing diagnosis of deficient fluid volume. Which of the following are data that support this diagnosis? Select all that apply.

Urine output that decreased from 60 to 40 mL/hr Heart rate that increased from 82 to 98 beats/min within 2 hours Fluid output of 2150 mL and total fluid intake of 2000 mL for the past 24 hours

The nurse is caring for a client with a duodenal ulcer. Which assessment findings indicate to the nurse that the client is experiencing perforation from the ulcer? Select all that apply.

Vomiting Tender and rigid abdomen Sudden drop in blood pressure Abdominal pain referred to the right shoulder

gastroenteritis and is febrile

at risk for FVD

normal bp

between 90/60mmHg and 120/80mmHg

the nurse is caring for a pt who has myelosuppression after chemotherapy the nurse should monitor for what

bleeding from the gums due to inhibited bone marrow production of blood cells and platelets

after surgery what must be reported to the provider

blood pressure that drops ten below their baseline bc blood pressure dropping is a sign of shock nurse mike says bp dropping is one of the first signs of shock

open wound or dehiscence

cover with sterile dressing

FES finding

decreased serum calcium level

When gastric analysis testing reveals excess secretion of gastric acid, the nurse recognizes which medical diagnoses is supported?

duodenal ulcer

pt is hypoglycemic give them

graham crackers

The nurse has documented an assessment on a 45-year-old male client on the third postoperative day following an open abdominal appendectomy.

has separated and has yellow drainage on dressing. clumps of yellow pus. 102 beats/min; respiratory rate, 22 breaths/min; temperature, 101.2°F (38.4°C) orally. White blood count 12.9 x 103 cells/mm3 (12.9 x 109 /l) blood glucose level 130 mg/dl (7.21 mmol/l).

which procedure places the client at highest risk for developing a DVT

hip arthroplasty

right hemisphere stroke

inability to recognize family members

for radiation look for...

infection (NOT hemoglobin, radiation typically does not affect hemoglobin) but if does effect wbc which places the client at risk for infection

A nurse is reviewing lab results for a client with an intestinal obstruction, and infection is suspected. What would be an expected finding?

leukocytosis; elevated hematocrit; low sodium, potassium, and chloride

cancer pt has neutropenia so implement which precaution

no plants or flowers in the room

myelosuppression

suppression of the blood cell-producing function of the bone marrow

pt has diverticular disease when palpating the pt where should the nurse expect the client to feel pain

the LLQ

what should nurse assess FIRST in the pacu after the pt has abdominal surgery

the dressing (bc hemorrhage this is priority)

med increasing risk for osteoporosis

thyroid hormones

with TPN ..

use a 1.2 micron filter when infusing tpn with fat emulsion

what vitamin is good for bone health

vitamin k and vitamin d