Nokea
During a health promotion seminar for senior citizens, a participant asks the nurse to discuss symptoms of gastric cancer. Which statement should be the basis for the nurse’s response?
- A. Cancers that do not penetrate the gastric muscular layer are asymptomatic in the majority of clients.
- B. Pain from early gastric cancer lesions cannot be reduced by over-the-counter (OTC) histamine receptor antagonists.
- C. Unexplained weight gain and increased body mass index (BMI) are early symptoms of gastric cancer.
- D. Anemia is uncommon in gastric cancer, but if it occurs, it is likely due to the effects of aging.
Correct Answer: A
Rationale: A. Eighty percent of clients with early gastric cancer do not have symptoms. B. Pain caused by gastric cancer can be alleviated by OTC histamine receptor antagonists. C. Weight loss and anemia are common symptoms, not weight gain and increased BMI. D. Anemia occurs from malabsorption and nutritional deficiencies, not the effects of aging.
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A client returns from having had abdominal surgery. Her vital signs are stable. She says she is thirsty. What should the nurse give her initially?
- A. Orange juice
- B. Milk
- C. Ice chips
- D. Mouth wash
Correct Answer: C
Rationale: Ice chips are safe to relieve thirst initially post-abdominal surgery, as clear liquids are introduced gradually until peristalsis returns.
The nurse is taking a hospital admission history of the client. The nurse considers that the client may have IBS when the client makes which statement?
- A. “I am having a lot of bloody diarrhea.”
- B. “I have been vomiting for 2 days.”
- C. “I have lost 10 pounds in the last month.”
- D. “I have noticed mucus in my stools.”
Correct Answer: D
Rationale: A. Clients with IBS may have diarrhea, but it is not bloody. B. Vomiting is not a symptom of IBS. C. Clients with IBS do not have unintentional weight loss. D. Mucus in the stools is a sign of IBS.
The client with a history of a duodenal ulcer is hospitalized with upper abdominal discomfort and projectile vomiting that has a foul odor. The nurse immediately notifies the HCP, concluding that the client may have developed which complication?
- A. Gastric perforation
- B. Gastrointestinal hemorrhage
- C. Gastric outlet obstruction
- D. Helicobacter pylori infection
Correct Answer: C
Rationale: A. Symptoms of perforation include severe abdominal pain; vomiting usually does not occur. B. The client with GI hemorrhage would have bright red or coffee-ground-colored emesis. C. Symptoms of gastric outlet obstruction include abdominal pain and projectile vomiting when the stomach fills enough to stimulate afferent nerve fibers relaying information to the vomiting center in the brain. The emesis may have a foul odor or contain food particles if the contents have been dormant in the stomach for a prolonged time period. D. Infection with H. pylori is not a complication of PUD; rather, it is a major cause of peptic ulcers.
The client recovering from acute pancreatitis who has been NPO asks the nurse, “When can I start eating again?” Which response by the nurse is most accurate?
- A. “As soon as you start to feel hungry you can begin eating.”
- B. “When I hear that your bowel sounds are active and you are passing flatus.”
- C. “When your pain is controlled and your serum lipase level has decreased.”
- D. “You will be NPO for at least more 2 weeks; oral intake stimulates the pancreas.”
Correct Answer: C
Rationale: A. Regaining appetite is a positive sign, but it must be accompanied by a decrease in pain before the client is allowed to take food orally. B. Intestinal peristalsis may be slowed due to inflammation associated with acute pancreatitis, but the return of bowel sounds and flatus is not used to determine when to begin oral intake. C. This response is correct. Once pain is controlled and the serum enzyme levels begin to decrease, the client can begin oral intake. These are signs that the pancreas is healing. D. There is no specific time limit for being NPO.
The charge nurse is making assignments. Staffing includes a registered nurse with five (5) years of medical-surgical experience, a newly graduated registered nurse, and two (2) unlicensed assistive personnel (UAPs). Which client should be assigned to the most experienced nurse?
- A. The 39-year-old client diagnosed with lower esophageal dysfunction who is complaining of pyrosis.
- B. The 54-year-old client diagnosed with Barrett's esophagus who is scheduled to have an endoscopy this morning.
- C. The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all five (5) lobes.
- D. The 68-year-old client who is three (3) days postoperative for hiatal hernia and needs to be ambulated four (4) times today.
Correct Answer: C
Rationale: The client with GERD and wheezing in all five lobes indicates potential respiratory complications, possibly asthma or aspiration, requiring complex assessment and management best suited for the experienced nurse. The other clients have less acute or complex needs.