Nokea
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.
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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 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 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.
An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client to know the diagnosis. What action by the nurse is best?
- A. Ask the family why they feel this way.
- B. Assess family concerns and fears.
- C. Refuse to comply with the family wishes.
- D. Tell the family that such secrets cannot be kept.
Correct Answer: B
Rationale: The nurse should use open-ended questions and statements to fully assess the family's concerns and fears. Asking why questions often puts people on the defensive and is considered a barrier to therapeutic communication. Refusing to comply or stating that secrets cannot be kept may set up an adversarial relationship.
A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client blood pressure when long days was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate?
- A. Administer ibuprofen (Motrin).
- B. Call the Rapid Response Team.
- C. Start a large-bore IV with normal saline.
- D. Tell the client to remain lying down.
Correct Answer: C
Rationale: This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse should start a large-bore IV with isotonic solution. Ibuprofen will exacerbate the ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the priority.