Nokea
A client has a peptic obstruction and reports sudden muscle-weakness. What action by the nurse takes priority?
- A. Document the findings in the chart.
- B. Request an electrocardiogram (ECG).
- C. Facilitate a serum potassium test.
- D. Administer a serum potassium test.
Correct Answer: B
Rationale: Pyloric stenosis can lead to hypokalemia, which is manifested by muscle weakness. The nurse first obtains an ECG because potassium imbalances can lead to cardiac dysrhythmias. A potassium level is also warranted, as is placing the client on the nurse. Priority. Documentation should be thorough, but none of these actions takes priority over the ECG.
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A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best?
- A. Ask your provider about it first.
- B. Slippery elm has no benefit for this problem.
- C. Slippery elm is often used for this disorder.
- D. There is no evidence that this will work.
Correct Answer: B
Rationale: Slippery elm is not recognized as an effective treatment for peptic ulcer disease. There is no evidence supporting its use for this condition, and it is not commonly recommended.
An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client?
- A. Check with the pharmacist before taking other medications.
- B. Increase intake of calcium and vitamin D.
- C. Report any worsening of symptoms to the provider.
- D. Take the medication for 2 months to be protected.
Correct Answer: B
Rationale: All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any anti-ulcer medication, specific to the use of esomeprazole.
A client is scheduled for a total gastrectomy for gastric cancer. What preoperative laboratory result should be reported to the surgeon immediately?
- A. Albumin: 2.1 g/dL
- B. Hematocrit: 28%
- C. Hemoglobin: 8.1 g/dL
- D. International normalized ratio (INR): 4.2
Correct Answer: D
Rationale: An INR as high as 4.2 poses a serious risk of bleeding during the operation and should be reported. The albumin is low and is an expected finding. The hematocrit and hemoglobin are also low, but this is expected in gastric cancer.
A nurse working with a client who has possible gastritis assesses the client's gastrointestinal system. Which findings indicate a chronic condition as opposed to acute gastritis? (Select all that apply.)
- A. Anorexia
- B. Dyspepsia
- C. Intolerance of fatty foods
- D. Pernicious anemia
- E. Nausea and vomiting
Correct Answer: C,D
Rationale: Intolerance of fatty or spicy foods and pernicious anemia are signs of chronic gastritis. Anorexia and nausea/vomiting can be seen in both conditions. Dyspepsia is seen in acute gastritis.
A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is appropriate?
- A. Alcohol intake of 1 to 2 drinks per week
- B. Family history of H. pylori infection
- C. Former smoker still using nicotine patches
- D. Willingness to adhere to drug therapy
Correct Answer: D
Rationale: Treatment for this infection involves either triple or quadruple drug therapy, which may make it difficult for clients to remain adherent. The nurse should assess the client's willingness and ability to follow the regimen. The other assessment findings are not as critical.