Galen medsurg exam #4
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 befor...
a client is provided with materials to obtain thre
what is a common gastrointestinal problem that old
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Galen medsurg exam #4
Galen medsurg exam #4
Galen medsurg exam #4
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Galen medsurg exam #4
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- 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 - Answer- 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 -
Answer- 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 - Answer- 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 - Answer- 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 - Answer- 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- 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- 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. - Answer- 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. -
Answer- 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. - Answer-
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. - Answer- 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. - Answer- 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.
The nurse is reviewing the medication history for a client diagnosed with
gastroesophageal reflux disease who has been prescribed esomeprazole (Nexium)
once daily. The client reports that the drug doesn't completely control the symptoms.
The nurse contacts the provider to discuss which intervention?
Adding a second proton pump inhibitor medication
Increasing the dose of esomeprazole
Changing to a twice-daily dosing regimen
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