Nokea
A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate?
- A. Do you have family or friends for support?
- B. I'd like to know what you are feeling now.
- C. Well, we knew this would probably happen.
- D. Would you like me to refer you to hospice?
Correct Answer: B
Rationale: The nurse assesses the client's emotional state with open-ended questions and statements and shows a willingness to listen to the client's concerns. Asking about support people is very limited in nature, and yes-or-no questions are not therapeutic. Saying that this was expected dismisses the client's concerns. The client may or may not be ready to hear about hospice, and this is another limited, yes-or-no question.
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The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)?
- A. Gastric acid inhibitor
- B. Histamine receptor blocker
- C. Mucosal barrier fortifier
- D. Proton pump inhibitor
Correct Answer: C
Rationale: Sucralfate is a mucosal barrier fortifier (protector). It is not a gastric acid inhibitor, a histamine receptor blocker, or a proton pump inhibitor.
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 client has a gastrointestinal hemorrhage and is prescribed two units of packed red blood cells. What actions should the nurse perform prior to hanging the blood? (Select all that apply.)
- A. Ask a second nurse to double-check the blood.
- B. Prime the IV tubing with normal saline.
- C. Prime the IV tubing with dextrose in water.
- D. Take and record a set of vital signs.
- E. Teach the client about reaction manifestations.
Correct Answer: A,B,D,E
Rationale: Prior to starting a blood transfusion, the nurse asks another nurse to double-check the blood (and client identification), primes the IV tubing with normal saline, takes and records a set of vital signs, and teaches the client about manifestations to report. The IV tubing is not primed with dextrose in water.
A nurse answers a clients call light and finds the client in the bathroom, vomiting large amounts of bright red blood. Which action should the nurse take first?
- A. Assist the client back to bed.
- B. Notify the provider immediately.
- C. Put on a pair of gloves.
- D. Take a set of vital signs.
Correct Answer: C
Rationale: All of the actions are appropriate; however, the nurse should put on a pair of gloves first to avoid communication with blood or body fluids.
A client who had a partial gastrectomy has several expected nutritional problems. What actions by the nurse are best to provide better nutrition? (Select all that apply.)
- A. Administer vitamin B12 injections.
- B. Ask the provider about folic acid replacement.
- C. Request a digestive enzyme supplement.
- D. Obtain consent for total parenteral nutrition.
- E. Provide iron supplements for the client.
Correct Answer: A,B,E
Rationale: After gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, and iron deficiency. The nurse should administer vitamin B12 injections, ask about folic acid replacement, and provide iron supplements. The client does not need enteral feeding or total parenteral nutrition.