Med surge exam 4

clinical manifestations for rolling hernia:

- feeling full after eating -breathlessness after eating -feeling of suffocation -chest pain mimicking angina -pain worse in the recumbent position

Pathophysiology for hypothyroidism:

- not enough T3 an T4 being produced by the thyroid -primary: the thyroid isn't doing its job secondary: problem with the pituitary gland

what are the s/s of hyperpituitarism with an increase GH?

- thickened lips -course facial hair -worsening of prognathism: increased pointy jaw -increase skull size -enlargement of internal organs -barrel chest -enlarged hands and feet -sleep apnea -hyperglycemia

post - acute diverticulitis diet:

- white brea/ pasta -very cooked vegetables with no skin -fruit with the skin removed (apple sauce, canned fruits) -eggs -lean meat

dx testing for cirrhosis:

-CT scan -abd ultrasound -biopsy: to see if its cancerous -HIDA scan -ERCP

dx testing for diverticulitis:

-CT scan w/ contrast dye -possible X-ray or abd ultrasound

dx testing for PUD:

-EGD -small bowel capsule endoscopy: swallow capsule w/ camera in it - eventually is defected out

non surgical treatment for small bowel obstruction:

-NGT decompression --> expect green/ yellow output from suction -NPO diet -IV hydration -PPI

clinical manifestations for cholecystitis:

-RUQ epigastric pain that can radiate to the right shoulder -biliary colic: intermittent waves of pain triggered by high fat meals -anorexia -N/V -dyspepsia -flatulence -blumbergs sign -erutication -if liver is involved: jaundice, clay colored stool, dark urine

preserving liver function:

-alcohol cessation -avoid hepatotoxic med including OTC meds -hep B titer if negative redo series

causes of cirrhosis:

-alcoholsim -viral hepatitis

hypopituitarism low TSH levels:

-all s/s hypothyroidism -treatment:m give levothyroxine

treatment for PUD:

-antacids -PPI -H2 antagonist -sucralfate -misoprostol -triple therapy quadruple therapy

clinical manifestations for hypothyroidism:

-cold -decrease in body temp -somnolence -cool, pale, dry skin -brittle hair -thick brittle nails -hypotension -bradycardia -wt gain d/t decrease metabolic rate -paresthesia -poor wound healing

transphenodial hypophysectomy

-concerned for cerebrospinal fluid leaks -mustache dressing in place for 2-3 days -nuero checks hourly for 24 hrs -assess drainage: check for glucose to determine if there is cerebrospinal fluid leakage/ yellow halo -head of bed elevated -dont blow nose, sneeze, or strain to have a BM -dont brush teeth for a couple of weeks: give mouth care several times a day -breath through mouth -deep breaths to prevent atelectasis and pneumonia -considerations for if they have it removed: -hormone replacement - usually prednisone and levothyroxine

hypopituitarism low levels of LH & FSH:

-decrease sex characteristics -decreased bone density and muscle strength -dont give to women after menopause increased risk for breast cancer Women: -amenorrhea -breast atrophy -decrease pubic/ axillary hair - decrease bone density -decrease libido Men: -decreased facial hair, ejaculate volume, muscle mass, bone density , body hair, libido

hypopituitarism low levels of growth hormone (GH):

-decreased bone density -decrease muscle strength/ weakness -elevated cholesterol levels in the blood stream -safety precautions

clinical manifestations of cirrhosis:

-dry skin (pruritis) -petechiae -ecchymosis -spider angiomas

clinical manifestations for sliding hernia:

-dyspepsia -regurgitation -coughing, hoarseness, wheezing at night -hypersalivation -dysphagia -epigastric pain -generalized abd pain -flatulence -erucication -nausea -globus -dental carries (the same manifestations as GERD)

nursing actions for cirrhosis:

-educate on alcohol cessation -educate about hepatitis -prevent hep A by hand washing -needle exchange programs -safe sex practices -monitor and trend labs: expect continuous labs -assess GI

labs for cirrhosis:

-elevated LFT -total protein in albumin (low) -bilirubin (elevated) -ammonia (normal in compensated) -PT/ INR (increased, clients are at risk for bleeding

clinical manifestations small bowel obstruction:

-expect to have NGT placed -abdominal pain and discomfort -bloating -upper abdominal distention -N/V -fluid and electrolyte imbalances -hyperactive/ normal BS

considerations for triple/ quadruple therapy:

-finish entire course of the med -s/s superinfection -dont take aspirin -s/s tinnitus -black tongue/ black stool may occur d/t pepto bismol -s/s GI bleed -take PPI 30 min before eating

nursing interventions for GERD:

-focused GI assessment (includes looking at the mouth) - respiratory assessment -have pt chew/ eat slowly -care for pts after EGDs -increase fluid and fiber: to prevent straining to have BMs -possible pain management w/ acetaminophen

desired outcome for hypopituitarism:

-fracture free -resolution/ improvement of s/s

what are the s/s of hyperpituitarism with an increase in PRL?

-galactorrhea: breast milk production outside of child birth -amenorrhea -infertiltity

Clinical manifestations for hyperthyroidism:

-goiter: enlarged thyroid -exophthalamos: bulging of the eyes unintentionally d/t increased intraocular pressure -tachycardia -increase basal body temp -heat intolerance -insomnia -tachypnea -shallow breathing -muscle weakness/ wasting -underweight with low BMI -amenorrhea -diarrhea

what are the general s/s of hyperpituitarism:?

-headache -vision changes

labs for cholecystitis:

-high cholesterol panel -potentially elevated WBC -CRP/ ESR --> for inflammation -if pancreas is involved : amylase & lipase -monitor bilirubin (may increase w/ stones)

treatment for diverticulosis:

-high fiber diet w/ fluid -stool softener -metamucil

clinical manifestations for large intestinal obstruction:

-intermittent lower abd cramping -borborygmi -obstipation (no bowel movements) / watery stool -lower abd distention -minimal to no vomiting

treatment for cholecystitis:

-laparoscopic cholecystectomy (becomes open procedure when gallbladder starts to die) -lithotripsy if pts are not candidates for surgery

potential complication of cirrhosis: hepatorenal syndrome

-liver and kindneys are not working --> when liver isnt working kidneys take over and then also fail (very late stage cirrhosis) -decreased urine output -increased creatinine -decrease GFR -assess for end stage renal disease

potential complication of cirrhosis: coagulopathy

-liver has decreased ability to make clotting factors because of decrease ability to use vit K -monitor INR -s/s bleeding -no anticoagulants -monitor H&H

nursing interventions for hypopituitarism:

-maintain safety -monitor labs -monitor and trend wt -med admin and education -psychosocial support d/t physical changes -prepare for dx testing -decrease in ACTH: trend K, Na, BG -decrease in GH: trend cholesterol -decrease in LH & FSH: trend H&H

nursing interventions for diverticulitis:

-monitor and trend BP, HR, temp -assist in prep for dx testing -IV 18 G from wrist up for CT scan -assess GI and cardiovascular -dont give laxatives -notify HCP is worse pain or rigid abdomen

nursing interventions for cholecystitis:

-monitor and trend labs -focused GI assessment -low fat diet for 2 weeks after cholecystectomy (avoid fried food, red meat, cheese, and whole milk products) -monitor JP drain sites -notify HCP of bile color drainage -discharge education (they may have shoulder pain but will go away in 2 wks) -avoid straining -s/s hernia notify HCP -s/s post colectomy syndrome (nausea and vomiting)

nursing interventions for a bowel obstruction:

-monitor and trend vitals -monitor and trend labs -NGT to suction will get some sort of fluid w/ potassium -pain management --> ketorolac, IV NSAIDs -may get anitbiotics to prevent infection -help prep for surgery and assess fro post op complications -if they have had surgery have them roll to their side and push up with their hand --> teach them how to splint

nursing interventions for hyperparathyroidism:

-monitor and trend vitals and labs -neuro focused assessment d/t tumor -s/s to report: loss of vision and increase in headaches -psychological considerations -s/s diabetes

nursing interventions for hyperthyroidism:

-monitor and trend vitals and labs -provide emotional support -nutritional support -RAI education and safety -thyroidectomy education

causes of diverticulosis:

-muscle weakness --> aging -constipation -straining to have a BM -lack of fiber in the diet

desired outcomes for diverticulitis/ osis

-no development of diverticulitis -soft formed stool

desired outcomes for PUD:

-no pain -no s/s PUD -improve/ maintain quality of life -pt is able to sleep

desired outcomes for GERD:

-no s/s GERD -maintain quality of life

desired outcome for hiatal hernia:

-no s/s hiatal hernia -improved quality of life

surgical treatment for a large bowel obstruction:

-open intestines and remove ball of stool -cannot bowel prep before this -mechanical --> exploratory laparotomy (at high risk for peritonitis and evisceration, NPO prior to this surgery w/ IV hydration)

treatment for diverticulitis:

-oral antibiotics managed at home -low fiber/ low residual diet -IV antibiotics/ NPO : in complicated -surgical management: hemicolectomy

potential complications for a bowel obstruction:

-peritonitis -after surgery: DVT, pneumonia, infection, evisceration, dehiscence -perforation

potential complications of hiatal hernia:

-pneumonia -GERD -pernicious anemia -infection -pneumothorax -volvulus: twisting and knotting of GI

potential complications of GERD:

-pneumonia: pleuritic chest pain, myalgia/ arthralgia, thick tenacious sputum, expect to treat with antibiotics -cancer -esophagitis -esophageal erosion/ bleeding -pain

desired outcomes for cirrhosis:

-preserve liver function -no signs of potential complications -adherence to lifestyle mods -no hepatoxic meds -alcohol cessation

thyroidectomy:

-removal of the thyroid -give psychosocial support -*immediate priority post op: ensure patent airway* -could have thyroid storm -monitor VS closely -crouque has to be at bedside -life long levothyroxine therapy

what dietary sources including iodine?

-salt -root vegetables -shellfish -seaweed

risk factors for intestinal obstruction:

-surgery -opioids -anesthesia -intestinal hernia --> mechanical

causes of hyperthyroidism:

-thyroid cancer -graves dz: autoimmune disorder where thyroid produces too much of the hormone -thyroiditis: d/t trauma -too much iodine in diet -too much levothyroxine

pathophysiology for hyperthyroidism:

-thyroid is over secreting the hormone -increased metabolism in all organs

Dx test for hyperthyroidism:

-thyroid scan -thyroid ultrasound

nursing interventions for hypothyroidism:

-trend and monitor weekly wt -monitor vitals -warm blankets -nutritional assessment -diet education -assess sleep pattern -educate on s/s hyperthyroidism -s/s myxedema coma

potential complications of hyperpituitarism:

-type II DM -loss of vision -fracture -depression -infertility -cerebrospinal fluid leak -uncontrolled pain

the nurse is caring for a client 0700-1500 status post open cholecystectomy. during 0700-1500 the client had their JP drained twice 45 mL and 30 mL; LR at 75 mL/hr continuously; vanco 250 mL run over two hrs; drank 320 mL w/ breakfast, 270 mL w/ lunch, and 120 mL w meds twice; and urinated 425 mL and 325 mL. what was the clients intake during the shift?

1680

the nurse just received report on their assigned clients. which of the following clients should the nurse evaluate first? a. a client w/ diabetes who reports feeling cool, clammy and shakiness b. a client w/ a stage II pressure injury verbalizing a pain of 5 c. a client who has a deficiency in ACTH that is due for a glucocorticosteroid d. a client w/ hypothyroidism who is due for scheduled dose of levothyroxine

a. a client w/ diabetes who reports feeling cool, clammy and shakiness

the nurse administers an older adult clients meds via gastrostomy tube in the long term care setting. which finding would necessitate holding the feeding and medications and notifying the HCP? select all a. absence of bowl sounds b. presence of abd distention c. residual capacity exceeding 300 mL d. positive guaiac test of abdominal contents e, seepage of feedings around tracheostomy

a. absence of bowl sounds b. presence of abd distention c. residual capacity exceeding 300 mL d. positive guaiac test of abdominal contents e, seepage of feedings around tracheostomy

the nurse is caring for a 76 yr old client who is obese and has a hx of epigastric distress, esophageal burning, binge drinking, and frequent episodes of bronchitis. a diagnosis of hiatal hernia is made. which health problems most likely contributed to the development of the hiatal hernia? select all a. aging b. obesity c. bronchitis d. esophagitis e. binge drinking

a. aging b. obesity

which goals are appropriate when caring for a client with hyperplasia of pituitary tissue? select all a. alleviate headache b. to replace lost sodium c. to eliminate visual disturbances d. to check the urine specific gravity e. to return hormone levels to normal

a. alleviate headache c. to eliminate visual disturbances e. to return hormone levels to normal

the nurse is taking care of a client w/ cirrhosis of the liver. which clinical manifestations would the nurse assess in the client? select all a. ascites b. hunger c. pruritus d. jaundice e. headache

a. ascites c. pruritus d. jaundice

a pt diagnosed w/ viral hepatitis develops liver failure and hepatic encephalopathy. which of these measures should the HCP include in the pts plan of care? select all a. assess DTR b. monitor the pts blood glucose c. monitor the pts PT d. institute droplet precautions e. provide high protein feedings

a. assess DTR b. monitor the pts blood glucose c. monitor the pts PT

the nurse is caring for a client who is hemorrhaging from a duodenal ulcer. which collaborative interventions should the nurse implement? select all a. assess the clients vitals b, admin opioid analgesics c. monitor the clients I&O d. obtain a type and cross for blood

a. assess the clients vitals c. monitor the clients I&O d. obtain a type and cross for blood

which clinical manifestation would the nurse expect the client with hypothyroidism exhibit? select all a. cool skin b. photophobia c. constipation d. preorbital edema e. decreased appetite

a. cool skin c. constipation d. preorbital edema e. decreased appetite

for which clinical indicator would the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? select all a. dark urine b. yellow skin c. pain on urination d. clay colored stool e. coffee ground vomitus

a. dark urine b. yellow skin d. clay colored stool

which lab values would the nurse expect in a client who has hypothyroidism secondary to hypopituitarism? select all a. decreased TSH b. decreased T3 c. decreased parathyroid hormone d. decreased calcitonin e. decreased T4

a. decreased TSH b. decreased T3 e. decreased T4

the nurse is caring for a client admitted to the hospital w/ primary hyperparathyroidism. which action should be included in this clients plan of care? a. ensuring a large fluid intake b. instituting seizure precautions c. encouraging complete bed rest d. providing a high calcium diet

a. ensuring a large fluid intake

the nurse is assessing a client w/ secondary cushing syndrome and understands that it is a disorder primarily related to: a. excessive secretion of ACTH b. chronic renal failure c. liver dysfunction d. decreased secretion of ACTH

a. excessive secretion of ACTH

the nurse is caring for a client with PUD who has been vomiting profusely at home before coming to the ED. for which vital sign change will the nurse expect for this client? a. hypotension b. tachypnea c. oxygen desaturation d. bradychardia

a. hypotension

what is the effect of the parathyroid hormone on bones? select all a. increased bone breakdown b. increased urinary excretion of calcium c. increased absorption of calcium d. increased sodium and phosphorus excretion e. increased serum calcium levels

a. increased bone breakdown c. increased absorption of calcium e. increased serum calcium levels

when obtaining a nursing hx from a client with suspected gastric ulcer, which s/s should the nurse assess? select all a. melena b. anorexia c. relief of epigastric pain after eating d. epigastric pain at night e. vomiting

a. melena b. anorexia e. vomiting

the nurse is caring for a client who has recently been diagnosed w/ H.pylori. which drugs does the nurse anticipate would be used for this client to manage the infection? select all a. metronidazole b. lansoprazole c. azithromycin d. tetracycline e. hydroxychloroquine

a. metronidazole b. lansoprazole d. tetracycline

prednisone is prescribed to a client status post transsphenoidal hypophysectomy. when teaching the client about the medication, which should the nurse include? select all a. monitor for edema b. discontinue med when symptoms subside c. reduce your dose in times of stress d. change positions slowly when taking the med e. increase sodium intake

a. monitor for edema

which adverse effect of aspirin therapy would the nurse advise the client with arthritis to report? select all a. ongoing nausea b. constipation c. easy bruising d. decreased pulse e. ringing in the ears

a. ongoing nausea c. easy bruising e. ringing in the ears

the nurse is caring for a client who reports stomach pain and heartburn. which assessment finding is most significant suggesting the clients ulcer is duodenal and not gastric? a. pain occurs 1 1/2 - 3 hrs after meal, usually at night b. the client is a man older than 50 yrs old c. pain is worsened with ingestion of food d. the client has a malnourished appearance

a. pain occurs 1 1/2 - 3 hrs after meal, usually at night

which type of pain would the nurse expect a client with a duodenal ulcer to report? a. pain that is relieved with eating b. pain that is worse with antacids c. pain that is relieved with sleep d. pain that is worse 1 hr after eating

a. pain that is relieved with eating

the nurse is preforming an admission assessment of a pt w/ acute cholecystitis should expect which clinical manifestations of this condition? select all a. pain triggered by high fat meals b. anorexia c. biliary colic d. eructation e. constipation

a. pain triggered by high fat meals b. anorexia c. biliary colic d. eructation

a pt diagnosed with hepatitis and cirrhosis has developed ascites. when assessing the pt the HCP notes an increased temp and decreased LOC. what assessment should the HCP preform next? a. palpate the abdomen for tenderness b. obtain a urine sample for analysis c. auscultate the pts lung sounds d. measure the pts abdominal girth

a. palpate the abdomen for tenderness

a home care nurse is completing a care plan for a client who has a long hx of hyperparathyroidism. which problem would be the priority for this client? a. the client is at increase risk for pathological fractures b. the client is having difficulty preforming self-care c. the client is experiencing a lack of appetite d. the client is at an increased risk for constipation

a. the client is at increase risk for pathological fractures

the nurse is most likely to report which of the following finding to the primary car provider for a client who has an established colostomy? a. the stoma color is a deep red purple b. an ascending colostomy delivers liquid feces c. the stomach extend 1/2 in above the abdomen d. the skin under the appliance looks red briefly after removing the appliance

a. the stoma color is a deep red purple

the family of a client who has hepatic encephalopathy asks why the client is restricted to moderate amounts of dietary protein and has to take lactulose. what is an appropriate response by the nurse? a. these interventions help to reduce the ammonia level b. these interventions help to prevent heart failure c. these interventions help the clients jaundice improve d. these interventions help to prevent nausea and vomiting

a. these interventions help to reduce the ammonia level

the client 2 days post op from a laparoscopic cholecystectomy tells the office nurse "my right shoulder hurts so bad and i cant stand it" which statement is the nurses best response? a. this is a result of the CO2 used in surgery b. increase the pain medication the surgeon ordered c. call 911 and fo to the ED immediately d. you need to ambulate in the hall to walk off the gas pains

a. this is a result of the CO2 used in surgery

which clinical manifestations exhibited by a client taking levothyroxine for hypothyroidism for 3 months would cause a nurse to suspect that a decrease dosage is needed? select all a. tremors b, bradychardia c. somnolence d. heat intolerance e. decreased BP

a. tremors d. heat intolerance

compensated cirrhosis pathophysiology:

able to meet bodys needs but not able to function optimally -liver will get smaller and fibrotic decompensated: s/s liver impairment

a client underwent a exploratory laparotomy 2 days ago as a treatment for a mechanical large bowel obstruction. the HCP should be called immediately for which physical finding? a. displacement of NGT b. abdominal distention and rigidity c. nausea and occasional vomiting d. absent or hypoactive bowel sounds

b. abdominal distention and rigidity

a nurse is caring for a client with a hiatal hernia. the client states that their favorite beverages include ginger ale, apple juice, OJ, and cola beverages. of the four the client listed, which is the only beverage that should remain in the clients diet? a. ginger ale b. apple juice c. orange juice d. cola beverages

b. apple juice

the nurse is reviewing lab results for a client on an endocrine unit. the client receiving supplemental oral calcium has a serum calcium level of 6.5. which of the following should the nurse do? a. request a repeat calcium level be drawn b. assess for trousseau's sign c. place the client on fall precautions d. check the expiration date on the calcium

b. assess for trousseau's sign rationale: always assess before doing

which nursing intervention is a priority for a client who is recovering from removal of a pituitary gland tumor? a. monitoring for increased temp b. assessing for signs of increased intracranial pressure c. maintaining a patent IV access d. offering the bedpan or urinary at least every 2 - 3 hrs

b. assessing for signs of increased intracranial pressure

the nurse is providing discharge instructions to a client diagnosed w/ cirrhosis and varices. which info would the nurse include in the teaching session? select all a. adhering to a low carb diet b. avoid aspirin and aspirin containing products c. limit alcohol consumptions to two drinks weekly d. avoid acetaminophen and products containing acetaminophen e. avoid coughing, sneezing, and straining to have a BM

b. avoid aspirin and aspirin containing products d. avoid acetaminophen and products containing acetaminophen e. avoid coughing, sneezing, and straining to have a BM

the nurse is caring for a client who just had a paracentisis. which client finding indicates that the procedure was effective? a. increase BP b. decreased wt c. increased pulse d. decreased pain

b. decreased wt

the pt with Hep A has asked if he can return to his job in a fast-food restaurant. what is the priority teaching for this client? a. the importance of weekly blood drawn for lover enzymes b. handwashing techniques and compliance with his employers standards c. keeping the appointment for an EGD to determine esophageal varices d. continuing the admin of warfarin

b. handwashing techniques and compliance with his employers standards

a client is admitted to the hospital with a diagnosis of peptic ulcer. which common complication would the nurse assess for in this client? a. perforation b. hemorrhage c. pyloric obstruction d. esophageal varices

b. hemorrhage

the nurse is caring for a client who has a gastric ulcer. for which potentially life threatening complication would the nurse monitor for this client? a. hypokalemia b. hemorrhage c. N/V d. infection

b. hemorrhage

a member of the clinic housekeeping staff experiences a needle stick by a contaminated needle. which of the following should be administered by the HCP to provide the pt w/ passive immunity against the hep B virus? a. antiviral medication b. hep B immune globulin c. hep B vaccine d. interferon

b. hep B immune globulin

an older clients colonoscopy reveals the presence of extensive diverticulosis. which type of diet would the nurse encourage the client to follow? a. low fat b. high fiber c. high protein d. low carb

b. high fiber

the nurse is educating a client w/ new diagnosis of GERD. which position should the nurse instruct the client to remain for several hrs after eating? a. left side lying b. high fowlers c. right side laying d. semi-fowlers

b. high fowlers

the nurse is obtaining a health hx from a client w/ a diagnosis of PUD. the nurse identifies a possible contributory risk factor when the client makes which statement? a. my blood type is A positive b. i smoke one pack of cigs a day c. i have been overweight most of my life d. my BP has been high lately

b. i smoke one pack of cigs a day

assessment findings for a pt diagnosed w/ portal HTN include oliguria and increase BUN. which additional assessment finding would be consistent w/ a diagnosis of hepatorenal syndrome? a. increased urine sodium b. increased serum creatinine c. flank pain and proteinuria d. hypotension and pallor

b. increased serum creatinine

which actions by the nurse would most likely help to relieve symptoms associated with ascites? a. monitoring serum albumin levels b. lowering the HOB c. administering oxygen d. administering IV fluids

b. lowering the HOB c. administering oxygen

which statement by a client w/ cirrhosis indicates that further instruction is needed about the disease? a. the scares on my liver create problems w/ blood circulation b. my liver is scarred, but the cells can regenerate themselves and repair the damage c. because of the scars on my liver, blood clotting and BP are affected d. cirrhosis is a chronic disease that has scared my liver

b. my liver is scarred, but the cells can regenerate themselves and repair the damage

which is the priority intervention for a dependent client w/ PUD who is vomiting bright red blood? a. apply oxygen b. place the client in a side lying position c. prepare to admin packed RBC d. assess the clients pulse and BP

b. place the client in a side lying position

a client with severe chron's dx develops a small bowel obstruction. which clinical finding would the nurse expect the client to report? a. bloody vomitus b. projectile vomiting c. bleeding w. defecation d. pain in LLQ

b. projectile vomiting

a client is admitted with hyperthyroidism. what is the most important intervention for the nurse to consider? a. keeping the client warm b. providing a calm restful environment c. encouraging the client to increase activity d. ensuring the client is in high fowlers position at all times

b. providing a calm restful environment d/t insomnia clinical manifestation

the nurse is inserting a NGT to a client 3 days after surgery because of suspected paralytic ileus. which information gathered during the insertion is considered normal? select all a. pH check of the aspirate of 3.2 b. small amount of blood tinged fluid after insertion is complete c. secretions consist of coffee ground emesis d. gasping and coughing as the tube is advanced e. slight gagging when the tube reaches the pharynx

b. small amount of blood tinged fluid after insertion is complete d. gasping and coughing as the tube is advanced e. slight gagging when the tube reaches the pharynx

the female client diagnosed with diverticulosis called the home health care agency and told the nurse, "i am having bad pain in my left lower stomach and i think i have a fever" which action would the nurse take? a. recommend the client to take an antacid and lie flat in bed b. tell the client to have someone drive them to the ER c. ask the client what she has had to eat in the last 8 hrs d. instruct one of the nurses to visit the client immediately

b. tell the client to have someone drive them to the ER

the pt diagnosed w/ lover problems asks the nurse, "why are my stools clay-colored?" which scientific rationale by the nurse is the best response? a. the liver is unable to metabolize fatty foods b. the liver is unable to excrete bilirubin c. there is an increase in serum ammonia levels d. a damaged liver cannot detoxify vitamins

b. the liver is unable to excrete bilirubin

a client reports a loss of 20 Ibs in 3 months and black, tarry stools, a colonoscopy is scheduled. which instructions would the nurse give to prepare the client for this test? a. the nurse instructs the client that a bland diet will be prescribed the night before the test b. the nurse tells the client not to eat or drink anything the morning of the test c. the nurse administers an oil retention enema right before the test d. the nurse explains that the pretest laxative will cause diarrhea after the test

b. the nurse tells the client not to eat or drink anything the morning of the test

gastric reflux pathophysiology:

backflow of stomach contents into the esophagus

dx testing for hiatal hernia:

barrium swallow w/ fluroscopy (can cause constipation)

which concentration of a clients serum calcium level will stimulate the release of parathyroid hormone? a. 10 b. 9 c. 8.5 d. 9.5

c. 8.5

the nurse should monitor for which client complication of hypoparathyroidism? a. graves dz b. tetany c. bone pain d. seizures

c. bone pain

the nurse assessing a client w/ hypothyroidism would notify the provider about which finding? a. bradycardia b. coarse hair c. constipation d. menorrhagia

c. constipation

which assessment finding would the nurse anticipate in a client who has selective hypopituitarism related to GH? select all a. decreased body hair b. decreased serum cholesterol c. decrease muscle strength d. increased serum cholesterol e. decreased tolerance to cold

c. decrease muscle strength d. increased serum cholesterol

a nurse is assessing a client who has been admitted w/ a diagnosis of an obstruction in the large intestine. the nurse should assess the client for which s/s? select all a. increased bowel sounds b. copious diarrhea c. dehydration d. epigastric pain e. abd distention

c. dehydration e. abd distention

which statement is important for the nurse to include in the teaching plan for a pt w/ IBS who has instructions to take psyllium for constipation? a. urine may be discolored b. stop taking the laxative once a BM occurs c. each dose should be taken with a full glass of water or juice d. daily use may inhibit the absorption of some fat-soluble vitamins

c. each dose should be taken with a full glass of water or juice

a client presents w/ gastric pain, vomiting, dehydration, weakness, lethargy, and shallow respirations. lab results indicate metabolic alkalosis. a diagnosis of gastric ulcer is made. which is the primary nursing concern? a. chronic pain b. risk for injury c. electrolyte imbalance d. inadequate gas exchange

c. electrolyte imbalance

the nurse is caring for a client who is 1 day post op from a total thyroidectomy. the nurse determines which of the following assessment findings requires immediate intervention? a. BP 160/ 92 b. weak voice and hoarseness c. harsh, high pitched respiratory sounds d. decreased deep tendon reflexes

c. harsh, high pitched respiratory sounds

a nurse should review the lab results of a client w/ cushings syndrome d/t an overproduction of ACTH. which clinical manifestations should the nurse monitor for? a. low WBC b. hypokalemia c. hyperglycemia d. decreased plasma cortisol levels

c. hyperglycemia

a pt is diagnosed w/ an infection caused by hep A. which statement if made by the pt, would indicate the pt needs further teaching about the infection? a. i will wash raw fruits and vegetables before i eat them b. before i take any OTC meds i should call the clinic c. i might get liver cancer someday because i have this infection d. it is important for me to wash my hands after i use the bathroom

c. i might get liver cancer someday because i have this infection

a client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. which would the nurse consider formulating a response> a. hypothyroidism is a gradual slowing of the bodys function b. a decrease in pituitary TSH will occur c. less thyroid tissue is available to supply thyroid hormone after surgery d. atrophy of tissue remaining after surgery reduces secretion of thyroid hormone

c. less thyroid tissue is available to supply thyroid hormone after surgery

the diet prescribed for a client with diverticulosis includes 30 g of fiber a day. which breakfast items would the nurse encourage the client to select? a. cream of wheat, milk, and cranberry juice b. unstrained OJ, pancakes, and bacon c. oatmeal, sliced bananas, whole wheat toast and milk d, poached eggs on whole wheat toast, tomato juice, and tea

c. oatmeal, sliced bananas, whole wheat toast and milk

which clinical manifestation is an early clinical manifestation of intestinal strangulation from bilateral inguinal hernia? a. increased faltus b. projectile vomiting c. sharp abd pain d. decreased bowel sounds

c. sharp abd pain

the nurse finds a client vomiting coffee ground emesis. on assessment the client has a BP of 100/74, is acutely confused, and has a weak and thready pulse. which intervention is the nurses first priority? a. admin antianxiety meds b. initiate enteral nutrition c. start IV fluids d. admin H2 antagonist

c. start IV fluids

the nurse is caring for a client following a transsphenoidal hypophysectomy. the nurse notes occasional clear fluid dripping from the nostril. which immediate action should the nurse take? a. evaluate the clients intake and output b. tape a loose dressing under the nostril to absorb the fluid c. test the clear fluid for the presence of glucose d. check the clients BP

c. test the clear fluid for the presence of glucose

the nurse is reviewing the morning lab results. which data should the nurse report to the HCP? a. the client who is 1 day post op total cholectomy w/ creation of an ileal conduit who has H&H of 12/36 b. the client who is 8 hrs post op for exploratory laporotomy who has serum potassium level of 4.5 mEq/L c. the client who is 4 hrs post op for gastric lap banding with a WBC of 15 d. the client who is 4 days post op for gastric bypass surgery whose FBS is 120 mg/dL

c. the client who is 4 hrs post op for gastric lap banding with a WBC of 15

the nurse is caring for the following clients on a surgical unit. what client should the nurse assess first? a. the client who is 6 hrs post colonoscopy and is being discharged b. the client with an inguinal hernia repair who has a urine output of 160 mL in 4 hrs c. the client with an emergency cholecystitis who was transferred from PACU d. the client who is 4 hrs post op abdominal surgery who has flatulence

c. the client with an emergency cholecystitis who was transferred from PACU

the nurse is admitting a client with hypothyroidism. during the initial assessment which symptoms should the nurse be alert for? a. polyuria, polydipsia, and wt loss b. coarsening of facial features and extremity enlargement c. tiredness, cold intolerance, wt gain, and constipation d. heat intolerance, nervousness, wt loss, and hair loss

c. tiredness, cold intolerance, wt gain, and constipation

which explanation would the nurse provide to a client with gastric ulcer dz who asks the nurse why the health care provider has prescribed metronidazole? a. to augment the immune response b. to potentiate the effect of antacids c. to treat H.pylori d. to reduce hydrochloric acid secretion

c. to treat H.pylori

the nurse is caring for a client with GERD. which information would the nurse provide the client to prevent worsening of the disorder? select all a. eat a snack before bed b. include vigorous exercise c. wear loose fitting clothing d. begin a wt loss program e. sleep with HOB elevated

c. wear loose fitting clothing d. begin a wt loss program e. sleep with HOB elevated

the nurse is caring for a client who has cirrhosis of the liver. the clients lab testing shows a prolonged PT. for what assessment finding would the nurse monitor? a. DVT b. jaundice c.hematemesis d. pressure injury

c.hematemesis

pathophysiology of GERD:

constant backflow of stomach contents into esophagus -stomach is the most acidic place in the body -repeated erosion of the stomach can turn into cancer -can be a risk factor for pneumonia

hypopituitarism low levels of ACTH:

cortisol and aldosterone decrease -treatment: give corticosteroids decrease glucocorticoids: -hyperkalemia -hypoglycemia -decrease ability to handle stress decreased mineralcorticoid: -hypotension -hyponatremia -hyperkalemia

what is a thyroid storm?

could happen from trauma or thyroidectomy -medical emergency -uncontrollable HTN (hypertensive crisis) -high fever -tachycardia -will expect to give them IV antihypertensives

what are the s/s of hyperpituitarism with an increase in ACTH?

cushings disease

the nurse is caring for a client returning to the surgical unit following a laparoscopic cholecystectomy. what finding is of the most concern? a. reports of shoulder pain b. pain rating 3 c. slight nausea when deep breathing and coughing d. 120 mL urine output over 5 hrs after returning to the surgical unit

d. 120 mL urine output over 5 hrs after returning to the surgical unit

a client has undergone nasal hypophysectomy surgery. during post op care, the nurse would monitor the client for which indication of cerebrospinal fluid drainage? a. dry mouth b. rigidity of neck muscle c. fall in blood pressure upon standing d. a yellow edge around nasal discharge

d. a yellow edge around nasal discharge

when preparing a client to undergo paracentitis, which action is necessary to reduce potential injury as a result of the procedure? a. assist the provider to insert a trocar catheter into the abdomen b. position the client w/ the HOB flat c. encourage the client to take deep breaths and cough d. ask the client to void prior to the procedure

d. ask the client to void prior to the procedure

the UAP tells the nurse a female client, who had laparoscopic cholecystectomy is complaining of abdominal pain. which intervention should the nurse implement? a. instruct the UAP to ask the client to rate their pain on a scale of 1-10 b. tell the UAP to to obtain the clients vitals and pulse ox reading c. check the medication admin on record for the last pain med the client received d. assess the client to rule out any post op surgical complications

d. assess the client to rule out any post op surgical complications

the nurse is caring for a client admitted with peritonitis. which finding in the medical record is most likely the cause? a. gastritis b. hiatal hernia c. diverticulosis d. bowel obstruction

d. bowel obstruction

the nurse is caring for a client with PUD. which assessment finding is the most serious? a. feeling full for several hrs after eating b. projectile vomiting c. burning sensation 2hrs after eating d. coffee ground emesis

d. coffee ground emesis

the nurse reviews a clients medical record., specifically the clients skull radiograph results. an abnormality in the endocrine gland situated in a depression of the sphenoid bone is noted on the report. the nurse recalls that which hormone release is most probably affected? a. glucagon b. cortisol c. aldosterone d. corticotropin

d. corticotropin

the nurse is providing the immediate post op care for a client who had fundoplication to reinforce the lower esophagus sphincter for the purpose of a hiatal hernia repair. what is the priority action for the care of this pt? a. assist the client to start taking a clear liquid b. administer pain medications c. assess the NGT for yellowish- green drainage d. elevate the HOB at least 30 degree

d. elevate the HOB at least 30 degree

a client experiences occasional RUQ pain attributed to cholecystitis. to prevent or minimize dyspepsia the nurse would instruct the client to avoid which food items? a. nuts and popcorn b. meatloaf and baked potato c. chocolate and boiled shrimp d. friend chicken and buttered corn

d. friend chicken and buttered corn

the nurse is recovering a client who has a esophagogastroduodenoscopy (EGD). what assessment would the nurse preform before determining if the client can have fluids to drink? a. bowel sounds b. orientation c. presence of bruit d. gag reflex

d. gag reflex

a client presents with flushed skin, exophthalmos and perspiration and states that he has been irritable and having palpations. the nurse interprets these symptoms as indicating which disorder? a. hashimoto dz b. cushings dz c. addison dz d. graves dz

d. graves dz

the nurse is teaching a client about GERD. which statement made by the client indicates correct understanding of GERD management? a. three meals a day is the best regimen to avoid GERD symptoms b. I can reduce my GERD symptoms through a high carb, low fat diet c. a snack at bedtime will help reduce the acidity of my stomach during the night d. i will place a 6 in block under the head of my bed to help with digestion

d. i will place a 6 in block under the head of my bed to help with digestion

a client is admitted to the hospital w/ a diagnosis of cholecystitis from cholelithiasis. the client has severe abd pain and nausea and has vomited 120 mL. based on these data, which nursing action would have the highest priority at this time? a. restore lost fluid b. replace the nutritional loss c. manage anxiety d. manage pain

d. manage pain

the nurse is caring for a client who just returned from an EGD and directs the UAP to get the client settled in the room. which action made by the UAP is incorrect? a. raising the head of bed b. straightening bed linens c. obtaining vitals d. offering client water

d. offering client water

a client is undergoing a transsphenoidal hypophysectomy. the nurse is aware that this procedure involves surgical resection of the: a. parathyroid gland b. thyroid gland c. adrenal gland d. pituitary gland

d. pituitary gland

the nurse is caring for a client in the midst of an addisonian crisis. which of the following is priority? a. assessing for HTN b. preventing infection c. increasing urine output d. preventing hypotension

d. preventing hypotension

a nurse is providing education for a client w/ cirrhosis who has a prolonged PT time and low platelet count. a regular diet is prescribed. which instruction would the nurse include in the teaching? a. avoid foods high in phytonadione b. check the pulse several x a day c. drink a glass of milk when taking aspirin d. report signs of bleeding no matter how slight

d. report signs of bleeding no matter how slight

the nurse collaborates with the registered dietician in providing teaching for a client who has ascites from cirrhosis. what daily dietary restriction would the nurse include in health teaching? a. calcium b. potassium c. magnesium d. sodium

d. sodium

the client is being prepared for a colonoscopy in the day surgery center. the charge nurse observed the primary nurse instructing the UAP to assist the client to the bathroom. which action should the charge nurse implement? a. discuss the inappropriate delegation of the nursing task b. tell the UAP to obtain a bedside commode for the client c. document the situation in adverse occurrence report d. take no action because this is appropriate delegation

d. take no action because this is appropriate delegation

during thyroid surgery a clients parathyroid glands have become damaged. which condition does the nurse expect the client to develop? a. goiter b, globe lag c. photophobia d. tetany

d. tetany

the client is diagnosed w/ esophageal bleeding. which of the following assessment data warrants immediate intervention by the nurse? a. the clients H&H 11.4/32 b. the clients NGT has coffee ground drainage c. the clients abdomen is soft to touch and non-tender d. the clients VS are T 99- HR 114- RR 18 -BP 88/60

d. the clients VS are T 99- HR 114- RR 18 -BP 88/60

a pt diagnosed with hepatitis develops splenomegaly. when reviewing the lab report which of the following results will the HCP anticipate? a. neutrophilia b. leukocytosis c. polycythemia d. thrombocytopenia

d. thrombocytopenia

which of the following is the best initial diagnostic test to determine a diagnosis of cholecystitis? a. HIDA b. CT scan w/ contrast c. chest x-ray d. ultrasound of right upper quadrant

d. ultrasound of right upper quadrant

the nurse is discharging a client w/ hypothyroidism. which client statement indicates the need for further teaching? a. when i go home i should check my HR and BP everyday b. i will call my provider if I notice any change in LOC c. i will be sure to include fiber in my diet and drink plenty of water d. when i am feeling better in a few months i will no longer need to take the levothyroxine.

d. when i am feeling better in a few months i will no longer need to take the levothyroxine.

the nurse is taking a health hx of a newly admitted patient w/ a diagnosis of r/o bowel obstruction. which question would you ask the pt as a priority? a. do you routinely use stool softeners, laxatives, or enemas? a. how often do you have a bowel movement? c. describe you bowel movements d. when was the last time you moved your bowels?

d. when was the last time you moved your bowels?

after care for exploratory laparotomy:

during surgery they will have a NG tube and IV hydration so nothing else will pass through the intestines allowing it to heal

the nurse caring for a client w/ an acute diagnosis of thyroid storm should expect to assess which of the following s/s? select all a. hypotension b. bradypnea c. hypothermia d. bradychardia e. hyperpyrexia

e. hyperpyrexia

clinical manifestations for gastric PUD:

epigastric pain to left side -30-60 min after a meal -rarely pain at night -worsens w/ food -little relief from antacids -if GI bleed will present as hematemesis

causes of diverticulitis:

food or fecal matter stuck in the diverticula

treatment for hyperthyroidism:

graves dz: -methimazole -PTU Thyroid cancer: -RAI -thyroidectomy

diverticulitis pathophysiology:

inflammation of diverticula that can lead to infection and perforation

pathophysiology for cholecystitis:

inflammation of the gallbladder -trapped bile is reabsorbed & acts as a chemical irritant to gallbladder wall cholelithiasis = gallbladder stone

potential complication of cirrhosis: portal hypertension

keeps portal vein from vasodialating causing increased pressure -increase pressure in vasculature leads to fluid shift --> ascites -monitor BP and HR

surgical treatment of GERD:

laparoscopic nissen fundoplication -minimally invasive

surgical treatment of hiatal hernia:

laparoscopic nissen fundoplication (LNF) -fundus is wrapped around the backside of the esophagus -no strenuous exercise, smaller meals, dont strain to have a BM -if a transthoracic approach pt will have a chest tube after

treatment for hypothyroidism:

levothyroxine

hypopituitarism:

low levels of hormone (usually one of these: -GH -LH & FSH -TSH -ACTH -MSH -PRL

labs to monitor for a small bowel obstruction:

monitor BMP --> at risk for dehydration and electrolyte imbalance

pathophysiology sliding hiatal hernia:

moves in / out of place d/t position changes and intra-abdominal changes

pathophysiology for peptic ulcer disease:

mucosal defenses become impaired, no longer protect epithelium from effects of acid and pepsin types: -gastric -duodenal -stress

diverticulosis pathophysiology:

multiple diverticula -no infection -chronically present -asymptomatic

desired outcome for bowel obstruction:

no further obstruction

labs for GERD

none that specifically tell us its is GERD checked to R/O other things: -H.pylori -H&H - for GI bleed

potential complication of cirrhosis: build up of bilirubin

nothing we can do for this will see jaundice, icterus, clay colored stool, dark colored urine

health promotion for PUD:

only applicable 1 for 1 month when the ulcer is healing -emphasis on stress management -"bland diet" avoid: -peppermint -chocolate -caffeine -fatty food -citrus -spicy food -tea -acidic food -carbonated drinks -eat smaller meals -dont eat 2 hrs B4 bed -stay upright 2 hrs after eating -sleep with HOB elevated -smoking cessation -maintain ideal body weight -avoid excessive vigorous exercise (can increase intra abd pressure) -avoid tight clothing -OTC med education (ex no NSAIDs)

pathophysiology rolling hernia:

part of the fundus moves up, above diaphragm and next to the esophagus

nursing interventions for a chest tube after LNF:

-assess site for infection -check tubing for kinking -should expect serous/ serosanguinous drainage -dont expect bubbling -check suction settings -assess for symmetry in breathing and for tracheal deviation -expect no change in LS -assess for subct emphysema -bedside supplies

mechanical intestinal obstruction:

-blocked by problems outside of the intestine: in bowel wall or intestinal lumen -intucception -volvulus -hernia -adhesions

potential complication of cirrhosis: ascites

-build up fo fluid in the peritoneal cavity r/t decrease in albumin -fluid shift test would tell us if its ascites -daily wts and abdominal girth -teach clients how to take abd girth at home -prior to having paracentisis clients have to urinate so we dont perforate the bladder

potential complication of cirrhosis: hepatic encephalopathy

-build up of ammonia -monitor neuro -they will be on lactulose take 2-3x a day

pharmological treatment for hiatal hernia:

-calcium carbonate -PPI -H2 antagonist

treatment of GERD:

-calcium carbonate -PPI -H2 antagonist -avoid: NSAIDs, sedatives, anticholinergics, nitrates, calcium channel blockers, and oral contraceptives

dx tests for cholecystitis:

-cholelithiasis: ultrasound -hepatobiliary scan (HIDA)--> uses contrast dye - magnetic resonance cholangiopancreatography (MRCP) --> MRI for the GI tract -X-ray -endoscopic retrograde cholangiopancreatography (ECRP) --> for minor stone (concerned for respiratory w/ this procedure)

RAI: radioactive iodine

-clients are completely isolated for 2-4 wks -no physical touch -laundry is not washed with others -use different bathrooms -bag incontinence and deliver to hospital to be disposed of -usually done outpatient -relief may not be for 6-8 wks after treatment -this procedure is NOT for pregnant people

dx testing for diverticulosis:

-colonoscopy -use osmotic laxatives for bowel prep

potential complication of cirrhosis: esophageal varices

-pressure form portal vein causes blood to backflow which causes increase in pressure in the esophagus, concern for bleeding, airway obstruction, and ability to rest -monitor s/s GI bleed -monitor BM--> we dont wan them to strain

non- mechanical intestinal obstruction:

-problem inside the intestine -stool -swallowing something that not supposed to be in there -tumor inside the intestine

potential complication for PUD: pyloric obstruction

-pt is unable to move food to the stomach -client will feel full and short of breath -NGT placed -they may need surgery -management of nutrition and NGT (IV fluids and hydration for NGT hooked up to suction)

desired outcomes for cholecystitis:

-resolved pain -adherence to lifestyle mods -follow post op diet

which instruction should the nurse include in the teaching plan for a client who is experiencing GERD? a. limit caffeine to two cups of coffee per day b. do not lie down for 2 hrs after eating c. take meds w/ milk to decrease irritation d. follow a low-protein diet

b. do not lie down for 2 hrs after eating

a client who is obese is diagnosed w/ a hiatal hernia. the nurse provides teaching about how to prevent esophageal reflux and should include which instruction? a. lie down after eating b. eat less food at each meal c. increase your fat intake d. drink more fluids at each meal

b. eat less food at each meal

which nursing problem is the highest priority for the client diagnosed with a newly placed ileostomy? a. alteration in bowel elimination b. fluid and electrolyte imbalance c. deficient knowledge d. alteration in bowel elimination

b. fluid and electrolyte imbalance

treatment for hyperpituitarism:

-medication -corticosteroids to stop production of ACTH -radiation to pituitary gland (at risk for burns) -transphenodial hypophysectomy

nursing interventions for hiatal hernia:

-monitor and trend VS -monitor pain -focused GI and respiratory assessment -chest tube after LNF

health promotion for GERD:

"bland diet" avoid: -peppermint -chocolate -caffeine -fatty food -citrus -spicy food -tea -acidic food -carbonated drinks -eat smaller meals -dont eat 2 hrs B4 bed -stay upright 2 hrs after eating -sleep with HOB elevated -smoking cessation -maintain ideal body weight -avoid excessive vigorous exercise (can increase intra abd pressure) -avoid tight clothing -OTC med education (ex no NSAIDs)

non surgical treatment for large bowel obstruction:

- non mechanical --> laxatives -mechanical --> need surgery

desired outcomes for hypothyroidism:

- wt within normal limits -vitals at baseline -regular sleep pattern -no s/s hypo/hyperthyroidism

desired outcomes for hyperthyroidism:

-VS within normal limits -wt back to baseline

labs to monitor for diverticulitis:

-WBC (expect slight increase) -CRP and ESR may be elevated

what is myxedema coma?

-a significant change in metabolism -thinning of the hair n -rapid edema -can impair the airway: *protecting the airway is the priority* - metabolism so low they cant wake up -pts will be cold

clinical manifestations for diverticulitis:

-acute LLQ abd pain -sharp -rebound tenderness -N/V --> from the pain -abdominal guarding -pts w/ diverticulitis in the sigmoid colon may experience more pain when their bladder is full -perforation: sudden sharp increase in pain -if development of peritonitis--> rigid board like abdomen

risk factors for PUD:

-alcohol -gastritis -tobacco -increased gastric acid -NSAIDs, corticosteroids

potential complications for PUD: upper/ lower GI bleed

UPPER: -monitor VS -trend H&H q 6 hrs -monitor coffee ground emesis, black tarry stool increased abd pain, decreased H&H treatment: -stablize VS with IV fluids -blood transfusion -EGD -NGT -gastric lavage LOWER: -upper endoscopy -s/s hematochezia

labs to monitor for large bowel obstruction:

WBC --> for perforation

a client is admitted via the ED with a tentative diagnosis of diverticulitis, the nurse anticipates that which test will be prescribed? a. CT b. gastroscopy c. colonoscopy d. barium enema

a. CT

the nurse is caring for a client admitted with joint pain and weakness. the client described a gradual coarsening of facial feature and enlargement of hands and feet over the past yr. the nurse should evaluate that this client is experiencing early clinical manifestations of which condition? a. acromegaly b. hypopituitarism c. cushings sydndrome d. graves dz

a. acromegaly

which action would the nurse consider to be most appropriate during the post op care to prevent cerebrospinal fluid leak in a client who has undergone a hypophysectomy? a. prohibiting coughing or sneezing b. encouraging deep breathing exercises c. assessing nasal drainage for quantity and quality d. monitoring the neurologic status for the first 24 hrs and then every 4 hrs

a. prohibiting coughing or sneezing

the nurse is completing a health assessment of a 42 yr old female with suspected graves dz. the nurse should assess this client for: a. tachycardia b. anorexia c. cold skin d. wt gain

a. tachycardia

which assessment finding would indicate the need for atenolol in a client with hyperthyroidism? select all a. tachycardia b. atrial fib c. distant heart sound d. systolic hypertension e. decreased cardiac output

a. tachycardia b. atrial fib d. systolic hypertension

potential complications for cholecystitis:

open abd surgery: dehiscence, evisceration, infection, DVT, pain

potential complications for diverticulitis:

perforation and peritonitis

what is the cause of hyperpituitarism:

pituitary tumor

surgical treatment for a small bowel obstruction:

repetitive small bowel obstruction: remove part of the intestine

clinical manifestations of duodenal PUD:

right upper quadrant epigastric pain -1.5-3 hrs after meal -pain at 1-2 am -relieved w/ food and antacids -if GI bleed will present as melena

potential complication for PUD: perforation

sharp sudden pain *surgical emergency (life threatening)* -feel muscle in peritoneal cavity -surgery will be needed: complete or partial removal of the stomach -of they develop dumping syndrome: lay them on their left side -NGT B4 surgery -antibiotics -at risk for evisceration and dehiscence -assess for rigid board like abdomen -at risk for malabsorption after procedure diet education: eat smaller meals

risk factors for cholecystitis:

the 4 F's -females -40 - fertile (pregnancy & hormonal replacement) -fat (gallbladder is overworked)

why do pts have an increased risk of a GI bleed when taking corticosteroids?

they decrease prostaglandin production which protects the stomach

labs to monitor for hiatal hernias:

to R/O PUD: H.pylori

diagnostic testing for intestinal obstruction:

to determine cause of obstruction -KUB -abdominal CT -abdominal ultrasound --> r/t other potential causes

causes of PUD:

trauma: -surgery -NPO -gastritis H.pylori

labs for hypothyroidism:

-TSH: increase in primary decrease in secondary -T3: decrease -T4: decrease

causes of GERD:

-anatomical abnormalities -increase abdominal pressure (d/t obesity or tight clothing) -NGT -excessive relaxation (d/t opioids or anesthesia) -hiatal hernia (anatomical change)

diverticulosis nursing interventions:

-assess GI -high fiber diet w/ enough oral fluids -life style changes: adequate exercise for BMs -s/s diverticulitis

dx testing for hyperpituitarism:

- CT or MRI -skull x-ray -supression testing

nursing interventions for PUD:

- GI assessment -med education -monitor for pain -monitor for complications

labs to monitor for hyperthyroidism:

- TSH: decrease in graves dz; increase in secondary -T3: increase -T4: increase

causes of hypothyroidism:

- aging -hashemotots : autoimmune disorder - radiation -medication -thyroidectomy -lack fo iodine in the diet: needed to make T3 and T4

clinical manifestations of GERD:

- dyspepsia -regurgitation -coughing, hoarseness, wheezing at night -hypersalivation -dysphagia -epigastric pain -generalized abd pain - flatulence -erucation: burping -nausea -globus: feeling like there is something stuck in the back of their throat -dental carries

lab tests for PUD:

-H.Pylori - go to lab value -hemoccult -gastroccult

dx testing for GERD:

Esophagogastroduodenostomy (EGD) -NPO B4 procedure -camera goes down throat and into stomach to look for abnormalities -cannot eat or drink anything red after the procedure -a positive EGD for GERD will show lower esophageal sphincter damage

which clinical indicator would the nurse review before scheduling a client for an endoscopic retrograde cholangiogpancreatography (ERCP)? a. urine output b. bilirubin level c. BP d. serum glucose

b. bilirubin level

clinical manifestations for diverticulosis:

asymptomatic