A client is provided with materials to obtain three fecal occult blood tests (Hemoccult). What health teaching does the nurse provide? Select all that apply.
A. "Avoid red meat and raw vegetables for a week before getting the samples."
B. "Drink a gallon of GoLYTELY before you collect the first s...
Galen medsurg exam 2024
A client is provided with materials to obtain three fecal occult blood tests (Hemoccult).
What health teaching does the nurse provide? Select all that apply.
A. "Avoid red meat and raw vegetables for a week before getting the samples."
B. "Drink a gallon of GoLYTELY before you collect the first sample."
C. "Do not take food or fluids for 24 hours before the test."
D. "Do not take ibuprofen for a week before obtaining the samples."
E. "Avoid vitamin C tablets, foods, and juices a week before getting the samples." -
Answer: A, D, E
Rationale: To avoid obtaining false-positive results associated with fecal occult blood
tests (Hemoccult), patients must avoid certain foods before the test, such as raw fruits
and vegetables and red meat. Vitamin C-rich foods, juices, and tablets must also be
avoided. Anticoagulants, such as warfarin (Coumadin), and nonsteroidal
antiinflammatory drugs should be discontinued for 7 days before testing begins.
What is a common gastrointestinal problem that older adults experience more frequently
as they age?
Decreased hydrochloric acid
Excess lipase production
Increased liver enzymes
Increased peristalsis - Atrophy of the gastric mucosa causes a decreased ratio of
gastrin-secreting cells to somatostatin-secreting cells. This results in a decrease in
hydrochloric acid, causing decreased absorption of iron and vitamin B12. In the
pancreas, calcification of pancreatic vessels occurs, with a decrease in lipase
production. The decrease in lipase results in decreased fat absorption and digestion.
Steatorrhea and diarrhea can subsequently occur. The number and size of hepatic cells
are decreased, which results in decreased enzyme activity; decreased liver enzyme
activity depresses drug metabolism, and therefore may cause accumulation of drugs to
toxic levels. In the large intestine, peristalsis is decreased and nerve impulses are
dulled, which can result in postponement of bowel movements in older adults.
A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal
pain. Which assessment technique does the nurse use for this client?
Assesses the abdomen in the following sequence: inspection, palpation, percussion,
auscultation
Examines the RUQ of the abdomen last
Has the client lie in a supine position with legs straight and arms at the sides - Views
the abdomen by looking directly down while standing over the client's abdominal area
cussion, and then palpation. This sequence prevents the increase in intestinal activity
and bowel sounds caused by palpation and percussion. The client would be positioned
supine with the knees bent, while keeping the arms at the sides to prevent tensing of
the abdominal muscles. It is best to inspect the abdomen by sIf the client reports pain in
,the RUQ, the nurse would examine this area last in the examination sequence. This
sequence prevents the client from tensing abdominal muscles because of the pain,
which would make the examination difficult. The sequence for examining the abdomen
is inspection, auscultation, pertanding at the side of the bed and then looking down on
the abdomen, and also from the side at eye level.
A client is admitted to the hospital with elevated serum amylase and lipase levels and a
decreased calcium level. Which gastrointestinal health problem is indicated by these
laboratory findings?
Acute pancreatitis
Cirrhosis
Crohn's disease
Diarrhea - These laboratory values are commonly found in clients with acute
pancreatitis. They are not indicative of cirrhosis of the liver or Crohn's disease. These
laboratory values are not found in a client with diarrhea.
The nurse is assessing a client who has come to the emergency department with acute
abdominal pain. The client is very thin and the nurse observes visible peristaltic
movements when inspecting the abdomen. What does the nurse suspect?
Acute diarrhea
Aortic aneurysm
Intestinal obstruction
Pancreatitis - Peristaltic movements are rarely seen except in thin clients and should be
reported since the finding may indicate an intestinal obstruction. Acute diarrhea does
not cause visible peristaltic movements. Aortic aneurysm may cause a bulging, pulsatile
mass. Pancreatitis is characterized by severe pain.
The nurse practitioner is performing an abdominal assessment on a newly admitted
client. In which order should the nurse proceed with assessment technique?
Auscultation, percussion, palpation, inspection
Inspection, auscultation, percussion, palpation
Palpation, percussion, inspection, auscultation
Percussion, auscultation, palpation, inspection - The abdomen is assessed by using
the four techniques of examination, but in a sequence different from that used for other
body systems: inspection, auscultation, percussion, and then palpation. This sequence
is preferred so that palpation and percussion do not increase intestinal activity and
bowel sounds. Nurse generalists may perform inspection, auscultation, and light
palpation; percussion and deep palpation may be done by advanced practice nurses.
A client with gastroesophageal reflux disease (GERD) is prescribed to start
pantoprazole (Protonix) 40 mg every day. Which statement by the client requires further
teaching by the nurse?
A. "When I feel better, I can stop taking this drug."
B. "I'll take this drug at 8 AM every morning."
C. "This drug can cause headache and dizziness."
D. "I should not crush the drug because it has a delayed release." - Answer: A
,Rationale: Treatment for GERD should be continued even if a client begins to feel
better. Discontinuation of therapy can result in return of original GERD symptoms, which
can further damage esophageal tissues. Side effects of pantoprazole (Protonix) can
include headache and dizziness, which should immediately be reported to the client's
health care provider. This medication should be taken on a regular, predictable
schedule because proton pump inhibitors provide effective, long-acting inhibition of
gastric acid secretion by affecting the proton pump of the gastric parietal cells. This
medication should not be crushed because of its delayed release properties.
Over the past 3 months, a client with a history of gastroesophageal reflux disease and
obesity has implemented lifestyle changes. What lifestyle changes does the nurse
recognize as important for the client to decrease chances of development of cancer of
the esophagus? Select all that apply.
A. Lost 10 pounds
B. Sleeps with two pillows
C. Has quit eating processed foods
D. Drinks a glass of wine every night
E. Uses a nicotine patch instead of smoking - Answer: A, B, C, E
Rationale: Losing weight can result in a decrease in intra-abdominal pressure, which
can reduce the symptoms of reflux that are associated with an increased risk for
development of esophageal cancer. Nocturnal reflux can be reduced by sleeping with
the head of the bed elevated or with the use of two pillows. Chemicals used in
processed foods, as well as smoking, can contribute to an increased risk for esophageal
(and other types of) cancer. Excessive alcohol intake is associated with esophageal
cancer.
The nurse prepares a teaching session regarding lifestyle changes needed to decrease
the discomfort associated with a client's hiatal hernia. Which change does the nurse
recommend to this client?
Eat only two or three meals daily.
Sleep flat in a left side-lying position.
Drink tea instead of coffee.
Avoid working while bent over the computer. - The client should avoid working while
bent over because this position presses on the diaphragm, causing discomfort. The
client with a hiatal hernia should eat four to six meals a day. The head of the client's bed
should be elevated approximately 6 inches. Both tea and coffee should be eliminated
from this client's diet because of the caffeine content.
The nurse is reinforcing the instructions on swallowing provided by the speech-
language pathologist to a client diagnosed with esophageal cancer. Which instruction to
the client is the highest priority?
Place food at the back of the mouth as you eat.
Do not be overly concerned with tongue or lip movements.
Before swallowing, tilt the head back to straighten the esophagus.
, Do not attempt to reach food particles that are on the lips or around the mouth. -
Placing food at the back of the mouth when eating will help the client avoid aspirating.
Both tongue movements and sealing of the lips should be monitored in this client. The
client's head should be tilted forward in the chin-tuck position. The client should be able
to reach food particles on her or his lips and around the mouth with the tongue.
A client has undergone conventional esophageal surgery. The client's diet has been
advanced to semi-solid, and feedings are well tolerated. The client reports experiencing
diarrhea about 1 hour after each meal. What is the priority nursing intervention to help
prevent further diarrhea?
Ensure that the client takes adequate amounts of fluids with meals.
Advance the diet to solid food and encourage eating as much as possible at meals.
Give the client a dose of magnesium hydroxide (Milk of Magnesia) after each meal.
Encourage the client to take fluids between meals rather than with meals. - Diarrhea is
believed to be the result of vagotomy syndrome and can be managed by taking fluids
between meals rather than with meals. For this client, fluids with meals can lead to the
development of diarrhea immediately after eating. The client may not be physically
ready to advance to a solid diet. The client should eat six to eight small meals daily.
Magnesium hydroxide is a magnesium-based antacid that can cause diarrhea.
The nurse is reviewing orders for a client with possible esophageal trauma after a car
crash. Which request does the nurse implement first?
Give total parenteral nutrition (TPN) through a central venous catheter.
Administer cefazolin (Kefzol) 1 g intravenously.
Obtain a computed tomography (CT) scan of the chest and abdomen.
Keep the client nothing by mouth (NPO) for possible surgery. - Clients with possible
esophageal tears should be NPO until diagnostic testing is completed, because leakage
of anything taken orally into the sterile mediastinum could occur. In addition,
esophageal rest is maintained for about 10 days after esophageal trauma to allow time
for mucosal healing. TPN is prescribed to provide calories and protein for wound
healing; although this is important, it is not a priority for the nurse to implement first.
Antibiotics may be requested to prevent possible infection, but this is not the priority. A
CT of the chest and abdomen will be needed, but is not the nurse's initial action.
A client in the outpatient clinic tells the nurse about experiencing heartburn and
nighttime coughing episodes. Which action does the nurse take first?
Teach the client about antacid effects and side effects.
Ask the client about medications and dietary intake.
Suggest that the client sleep with the head elevated 6 inches.
Tell the client to avoid drinking alcohol late in the evening. - The nurse's initial action
should be further assessment of the client's risk factors for gastroesophageal reflux
disease. Before suggesting interventions or beginning client teaching, the nurse must
elicit more information about the client's symptoms. The nurse needs additional data
before telling the client to avoid drinking alcohol late in the evening.
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