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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.
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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.
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.
A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate?
- A. Assess the client for iodine or shellfish allergies.
- B. Educate the client on the side effects of sedation.
- C. Inform the client a second scan may be needed.
- D. Teach the client about bowel preparation for the scan.
Correct Answer: C
Rationale: A second scan may be performed in 1 to 2 days to see if interventions have worked. The nuclear medicine scan does not use iodine-containing contrast dye or sedation. There is no required bowel preparation.
The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following? (Select all that apply.)
- A. Alcohol
- B. Caffeine
- C. Corticosteroids
- D. Fruit juices
- E. Nonsteroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: A,B,C,E
Rationale: Risk factors for acute gastritis include alcohol, caffeine, corticosteroids, and chronic NSAID use. Fruit juice is not a risk factor, although in some people it does cause distress.
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.