gastro

Question 1

The physician orders ranitidine hydrochloride (Zantac) 150 mg PO daily for the client. The nurse should advise the client the BEST time to take the medication is which of the following?

1. Prior to breakfast.
2. With dinner.
3. With food.
4. At hour of sleep.

Answer 1

Show/hide explanation
Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?

(1) absorption is not affected by food
(2) absorption is not affected by food
(3) absorption is not affected by food
(4) correct—best results when taking once a day

Question 2

The nurse is called to the room of a patient 4 days after abdominal surgery. The patient had been coughing and said he “felt something give.” The nurse observes that the edges of the incision have separated, and a small loop of the bowel protrudes through the incision. The nurse should position the patient in which of the following positions?

1. Head of the bed elevated 30°.
2. Head of the bed tilted down.
3. Head of the bed elevated 15°.
4. Head of the bed elevated 90°

Answer 2

Show/hide explanation
Strategy: Answers are all implementations. Determine the outcome of each answer choice. Is it desired?

(1) semi-Fowler’s; too high, puts pressure on abdominal area
(2) Trendelenburg position; impedes respiratory excursion
(3) correct—low Fowler’s; reduces stress on suture line, may be placed supine with hips and knees bent
(4) high Fowler’s; too high, puts pressure on abdominal area

Question 3

A patient is returned to the room following an appendectomy. The nurse notices a large amount of serosanguineous drainage on the dressing. It is MOST important for the nurse to obtain an answer to which of the following questions?

1. "Were there any intraoperative complications?"
2. "Has the dressing been changed?"
3. "Why didn't the recovery room nurse report any drainage?"
4. "Was a tissue drain placed during surgery?"

Answer 3

Show/hide explanation
Strategy: Determine how each answer choice relates to an appendectomy.

(1) doesn’t indicate understanding that drainage may be normal after this surgery
(2) first dressing usually changed by physician
(3) doesn’t indicate understanding that drainage may be normal after this surgery
(4) correct—drain is frequently placed during surgery to prevent accumulation in wound, dressing should be reinforced

Question 4

The physician prescribes cimetidine (Tagamet) 300 mg PO qid for an elderly client. The nurse instructs the client about the medication. Which of the following statements, if made by the client, indicates further teaching is needed?

1. "I'll take this pill with meals and before bed."
2. "I may experience mild diarrhea for a while."
3. "My stools may change color while I'm on this medication."
4. "I should call my doctor if I get an acne-like rash."

Answer 4

Show/hide explanation
Strategy: “Further teaching” indicates incorrect information

(1) taking with meals ensures consistent therapeutic effect
(2) common side effect, usually subsides
(3) correct—no change in stool color
(4) side effect seen with medication

Question 5

A client undergoes an appendectomy and the nurse performs discharge teaching. The nurse determines that teaching is effective if the client states which of the following?

1. "I shall eat a diet low in protein, high in carbohydrates, low in fats."
2. "I shall eat a diet high in protein, high in calories, high in vitamin C."
3. "I shall eat a diet high in protein, low in calories, low in fat."
4. "I shall eat a diet low in protein, low in carbohydrates, high in vitamin D.

Answer 5

Show/hide explanation
Strategy: Topic of question is unstated. Read the answer choices for clues.

(1) needs high-protein diet to maintain anabolic state, diet should contain adequate carbohydrates and be low in fat
(2) correct—supplemental vitamin C, iron, and multivitamins aid in wound healing and formation of RBCs
(3) needs high calories to promote wound healing
(4) needs high protein and high-calorie diet to maintain anabolic state

Question 6

The nurse cares for a patient 36 hours after a traditional cholecystectomy. The nurse is MOST concerned if which of the following is observed?

1. The patient complains of severe abdominal pain in the right upper quadrant.
2. 500 mL of greenish-brown fluid drained from the T-tube in the last 24 hours
3. The patient has received an antiemetic twice since surgery.
4. Lab tests indicate an Hgb of 14 g/dL, Hct of 44%, and WBC of 6,000/mm3

Answer 6

Show/hide explanation
Strategy: “MOST concerned” indicates a complication.

(1) correct—could indicate peritonitis or wound infection
(2) expected drainage, usually 500-1000 mL/day initially, will gradually decrease
(3) some nausea expected
(4) results within normal limits, normal Hgb: male 13.5-17.5 g/dL, female 12-16 g/dL, normal Hct: male 41-53%, female 36-46%, normal WBC 5,000-10,000/mm3

Question 7

A client has surgery for cancer of the colon, and a colostomy is performed. Before discharge, the client states that he will no longer be able to swim. Which of the following responses by the nurse is BEST?

1. "You should begin looking for other areas of interest."
2. "You will have to wear a watertight dressing over the stoma."
3. "You cannot go into water that covers the stoma area."
4. "You may resume all previous activities."

Answer 7

Show/hide explanation
Strategy: Determine the outcome of each answer choice. Is it desired?

(1) not appropriate for a client after a colostomy
(2) not appropriate for a client after a colostomy
(3) not appropriate for a client after a colostomy
(4) correct—all activities that the client participated in before the colostomy may be resumed after appropriate healing of the stoma or incisions