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23 Cards in this Set
- Front
- Back
- 3rd side (hint)
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1. The nurse and the dietitian are planning sample diet menus for the client who is experiencing dumping syndrome. Which sample meal is best for this client? |
* Chicken salad on whole wheat bread |
Chicken and rice Correct Correct: Chicken and rice is the only selection suitable for the client who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products. |
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2. The client with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 lbs of body weight has been regained. The client is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this client? |
* Explain to the client the importance of drinking the enteral supplements prescribed. * Ask the client's family to try to persuade the client to drink the supplements. * Inform the client that a nasogastric tube may be necessary if he or she fails to comply. * Ask the client if a change in flavor would make the supplement more palatable. |
Ask the client if a change in flavor would make the supplement more palatable. Correct Correct: This action shows that the nurse is attempting to determine why the client is not drinking the supplements. Many clients cannot tolerate certain supplement flavors. |
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3. The client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? |
* Schedule of the client's follow-up examinations and x-ray assessments * Information on family members' progress in learning how to perform dressing changes * Copy of the diet plan prepared for the client by the hospital dietitian * Detailed account of what occurred during the client's surgical procedure |
Schedule of the client's follow-up examinations and x-ray assessmentsCorrect Correct: Because recurrence of gastric cancer is common, it will be a priority for the client to have follow-up examinations and x-rays, so that a recurrence can be detected quickly. |
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4. The client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? |
* "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." * "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." * "What has your doctor told you about how your gastritis developed?" * "Yes, a familial tendency to inherit Crohn's disease as well as gastritis has been reported. Have your other family members been tested for Crohn's disease?'' |
"We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop."Correct Correct: This is the only accurate statement. Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs. |
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5. The client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? |
* "No, they probably won't be useful. You should use only prescription medications in your treatment plan." * "These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen." * "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." * "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe." |
"These herbs could be helpful. However, you should talk with your physician before adding them to your treatment regimen." Correct Correct: Although these herbs may be helpful in managing PUD, the client should consult his or her physician before making a change in the treatment regimen. |
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6. The nurse is teaching the client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates correct understanding of the nurse's instruction? |
* "It is okay to continue to drink coffee in the morning when I get to work." * "I will need to take vitamin B12 shots for the rest of my life." * "Ibuprofen (Advil, Motrin, others) can be taken for my headaches instead of aspirin." * "Small meals should be eaten about six times a day." |
"Small meals should be eaten about six times a day." Correct Correct: The client with chronic gastritis should eat six small meals daily to avoid symptoms. |
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7. The client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? |
* "Pain control is a major component of the care provided by hospice and its staff members." * "What has your doctor told you about participating in hospice?" * "I can speak to your physician about requesting adequate pain medication." * "You don't want to become too dependent on pain medication and become an addict." |
"Pain control is a major component of the care provided by hospice and its staff members." Correct Correct: This response correctly describes the services provided by hospice and its staff members, and helps reassure the client about their expertise in pain management. |
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8. The client is exhibiting symptoms of gastritis. The nurse is assessing the client to determine whether the form of gastritis being experienced is acute or chronic. Which data are correlated with a diagnosis of chronic gastritis? |
* Anorexia, nausea, and vomiting * Frequent use of corticosteroids * Hematemesis and anorexia * Treatment with radiation therapy |
Treatment with radiation therapy Correct Correct: Treatment with radiation therapy is known to be associated with the development of chronic gastritis. |
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9. The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which syndrome is most significant in determining whether the client's ulceration is gastric or duodenal in origin? |
* Pain occurs 1 1/2 to 3 hours after a meal, usually at night. * Pain is worsened by the ingestion of food. * The client has a malnourished appearance. * The client is a man older than 50 years. |
Pain occurs 1 1/2 to 3 hours after a meal, usually at night. Correct Correct: A key symptom characteristic of duodenal ulcers is that pain usually awakens the client between 1 AM and 2 AM, occurring 1 1/2 to 3 hours after a meal. |
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10. The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? |
* Starting a large-bore intravenous (IV) * Administering intravenous (IV) pain medication * Preparing equipment for intubation * Monitoring the client's anxiety level |
Starting a large-bore intravenous (IV) Correct Correct: A large-bore IV should be placed as requested, so that blood products can be administered. |
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11. The nurse is teaching the client with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? |
* "Nizatidine (Axid) needs to be taken three times a day to be effective." * "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." * "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." * "Omeprazole (Prilosec) should be swallowed whole and not crushed." |
"Nizatidine (Axid) needs to be taken three times a day to be effective." Correct Correct: Nizatidine (Axid) is most effective if administered twice daily. |
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12. The nurse is monitoring the client with gastric cancer for signs and symptoms of upper GI bleeding. Which change in vital signs is most indicative of bleeding related to cancer? |
* Respiratory rate from 24 to 20 breaths/min * Apical pulse from 80 to 72 beats/min * Temperature from 98.9° F to 97.9° F * Blood pressure from 140/90 to 110/70 mm Hg |
Blood pressure from 140/90 to 110/70 mm Hg Correct Correct: A decrease in blood pressure is the most indicative sign of bleeding. |
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13. The nurse finds a client vomiting coffee ground-type material. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention will be the nurse's first priority? |
* Administering an H2 antagonist * Initiating enteral nutrition * Administering intravenous (IV) fluids * Administering antianxiety medication |
Administering intravenous (IV) fluids Correct Correct: Administration of IV fluids is necessary to treat the hypovolemia caused by acute GI bleeding. |
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14. The nurse has placed a nasogastric (NG) tube in the client who has overdosed to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? |
* "Saline goes down the tube to help clean out your stomach." * "Medicine goes down the tube to help clean out your stomach." * "The doctor requested the tube to be placed just in case it was needed." * "We'll start feeding you through it once your stomach is cleaned out." |
"Saline goes down the tube to help clean out your stomach." Correct Correct: Gastric lavage involves the instillation of water or saline through an NG tube to clear out stomach contents. |
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15. The nurse is teaching the client about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the client indicates a need for further teaching? |
* "Sweetened fruit juice beverages will need to be avoided." * "Ice cream can be eaten in moderation." * "I cannot drink alcohol at all." * "It is okay to have a serving of sugar-free pudding." |
"Ice cream can be eaten in moderation." Correct Correct: Milk products such as ice cream must be eliminated from the diet of the client with dumping syndrome. |
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16. The client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? |
* Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician * Asking the physician for a referral for home health services to assist with dressing changes * Asking the spouse whether other family members could be taught how to change the dressing * Trying to determine specific concerns that the spouse has regarding dressing changes |
Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the physician Correct Correct: Providing the spouse with both oral and written instructions on symptoms to report to the physician, as well as on how to perform the dressing change, will reinforce important points and boost the spouse's confidence. |
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17. The client is an older woman diagnosed with Zollinger-Ellison syndrome. Which statement made by the client's family demonstrates correct understanding of the disorder? |
* "She may have to be treated with chemotherapy drugs." * "This is going to be a chronic problem that cannot be cured." * "At least this is not an inherited ailment." * "Thank goodness she won't have to undergo surgery." |
"She may have to be treated with chemotherapy drugs." Correct Correct: The client may undergo treatment with chemotherapeutic agents to reduce the tumor before further treatment can commence. |
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18. The client with peptic ulcer disease (PUD) asks the nurse whether a maternal history of ovarian cancer will cause the client to develop gastric cancer. What is the nurse's best response? |
* "Yes, it is known that a family history of ovarian cancer will cause someone to develop gastric cancer." * "If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing." * "Have you spoken to your physician about your concerns?" * "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food." |
"If you are concerned that you are at high risk to develop gastric cancer, I would recommend that you speak to your physician about the possibility of genetic testing."Correct Correct: Genetic counseling will help the client determine whether he is at exceptionally high risk to develop gastric cancer. |
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19. Which nursing action is best for the charge nurse to delegate to an experienced licensed practical nurse/vocational nurse (LPN/LVN)? |
* Re-tape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy. * Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. * Document instructions for a client with chronic gastritis about how to use "triple therapy." * Assess the gag reflex for a client who has arrived from the postanesthesia care unit (PACU) after a laparoscopic gastrectomy. |
Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. Correct Correct: Reinforcement of teaching done by the nurse is within the scope of practice for an LPN/LVN. |
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20. The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40, pulse 124, and respiratory rate 26. Which admission request will the nurse implement first? |
* Type and crossmatch for 4 units of packed red blood cells. * Infuse lactated Ringer's solution at 200 mL/hr. * Give pantoprazole (Protonix) 40 mg IV now and then daily. * Insert nasogastric tube and connect to low intermittent suction. |
Infuse lactated Ringer's solution at 200 mL/hr. Correct Correct: The client's most immediate concern is the hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia. |
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21. The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request will the nurse implement first? |
* Apply antiembolism stockings. * Place nasogastric (NG) tube, and connect to suction. * Insert an indwelling catheter, and check output hourly. * Give famotidine (Pepcid) 20 mg IV every 12 hours. |
Place nasogastric (NG) tube, and connect to suction. Correct Correct: To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis. |
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22. The nurse working during the day shift on the medical unit has just received report. Which client will the nurse plan to assess first? |
* Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy * Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal * Middle-aged client with Zollinger-Ellison syndrome who needs to receive omeprazole (Prilosec) before breakfast * Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy |
Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy Correct Correct: This client is experiencing symptoms of acute gastric dilation, which can disrupt the suture line. The surgeon should be notified immediately because the nasogastric tube may need irrigation or repositioning. |
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23. The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil, Motrin, others) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? |
* Bismuth subsalicylate (Pepto-Bismol) * Magnesium hydroxide (Maalox, Mylanta) * Metronidazole (Flagyl) * Misoprostol (Cytotec) |
Misoprostol (Cytotec) Correct Correct: Misoprostol (Cytotec) is a prostaglandin analogue that protects against NSAID-induced ulcers. |
