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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.
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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 had an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort measure may the nurse delegate to the unlicensed assistive personnel (UAP)?
- A. Irrigate the NG tube.
- B. Performing frequent oral care.
- C. Re-positioning the tube every 4 hours.
- D. Taking and recording vital signs.
Correct Answer: B
Rationale: Clients with NG tubes need frequent oral care both for comfort and to prevent infection. Irrigating the tube is done by the nurse. Re-positioning the tube, if needed, is also done by the nurse. The UAP can take vital signs, but this is not a comfort measure.
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 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.
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.