Nokea
The experienced nurse is instructing the new nurse. The experienced nurse explains that the definitive diagnosis of PUD involves which test?
- A. A urea breath test
- B. Upper GI endoscopy with biopsy
- C. Barium contrast studies
- D. The string test
Correct Answer: B
Rationale: A. A urea breath test only tests for the presence of Helicobacter pylori (H. pylori). B. The gastric mucosa can be visualized with an endoscope. A biopsy is possible to differentiate PUD from gastric cancer and to obtain tissue specimens to identify H. pylori. These are used to make a definitive diagnosis of PUD. C. Barium studies do not provide an opportunity for biopsy and H. pylori testing. D. A urea breath test and a string test only test for the presence of H . pylori.
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The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto-Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse the medications are effective?
- A. A decrease in alcohol intake.
- B. Maintaining a bland diet.
- C. A return to previous activities.
- D. A decrease in gastric distress.
Correct Answer: D
Rationale: A decrease in gastric distress (e.g., epigastric pain) indicates effective treatment of H. pylori and ulcer healing. Lifestyle changes like reduced alcohol or bland diets support treatment but are not direct indicators of medication efficacy.
The nurse is caring for clients on a surgical unit. Which client should the nurse assess first?
- A. The client who had an inguinal hernia repair and has not voided in four (4) hours.
- B. The client who was admitted with abdominal pain who suddenly has no pain.
- C. The client four (4) hours postoperative abdominal surgery with no bowel sounds.
- D. The client who is one (1) day postappendectomy and is being discharged.
Correct Answer: B
Rationale: Sudden resolution of abdominal pain may indicate perforation (e.g., appendicitis), a life-threatening emergency requiring immediate assessment. Urinary retention, absent bowel sounds, and discharge are less urgent.
Following an esophagectomy with colon interposition (esophagoenterostomy) for esophageal cancer, the client is beginning to eat oral foods. The nurse monitors for aspiration because the client no longer has which structure?
- A. A stomach
- B. A pyloric sphincter
- C. A pharynx
- D. A lower esophageal sphincter
Correct Answer: D
Rationale: A. All or part of the stomach will remain intact following an esophagoenterostomy. B. The pyloric sphincter will remain intact following an esophagoenterostomy. C. The pharynx will remain intact following an esophagoenterostomy. D. An esophagectomy for cancer involves removal of the lower esophageal sphincter, which normally functions to keep food from refluxing back into the esophagus. The absence of the lower esophageal sphincter places the client at risk for aspiration.
An adult is being treated for a peptic ulcer. The physician has prescribed cimetidine (Tagamet) for which reason?
- A. It blocks the secretion of gastric hydrochloric acid.
- B. It coats the gastric mucosa with a protective membrane.
- C. It increases the sensitivity of histamine (H2) receptors.
- D. It neutralizes acid in the stomach.
Correct Answer: A
Rationale: Cimetidine, an H2 receptor blocker, reduces gastric acid secretion, aiding peptic ulcer healing.
The nurse is caring for the newly admitted client with acute necrotizing pancreatitis. Which interventions, if prescribed, should the nurse implement?
- A. NS 1000 mL IV over 1 hour, then IV fluids at 250 mL/hour
- B. Initiate nasojejunal enteral feedings with a low-fat formula
- C. Imipenem-cilastatin 500 mg IV every 6 hours
- D. Up to chair for meals and ambulate four times daily
- E. Position left side-lying with head of bed elevated 30 degrees
- F. Insert a urinary catheter; monitor urine output every 2 hours
Correct Answer: A, B, C, F
Rationale: Giving an IV bolus followed by fluids at 250 mL/hour should be implemented. A large amount of fluids is lost due to third spacing into the retroperitoneum and intraabdominal area. Fluids are needed to prevent hypovolemia and maintain hemodynamic stability. B. Nasojejunal enteral feedings with a low-fat formula should be initiated to decrease the secretion of secretin, meet calorie needs, and maintain a positive nitrogen balance. C. Antibiotics, usually medications of the imipenem class such as imipenem-cilastatin (Primaxin), are used when pancreatitis is complicated by infected pancreatic necrosis. They have greater potency and a broader antimicrobial spectrum than other beta-lactam antibiotics. D. The client should be maintained on bedrest to decrease the metabolic rate and therefore reduce pancreatic secretions. E. Discomfort frequently improves with the client in the supine position rather than side-lying. F. A urinary catheter should be inserted to closely monitor urine output for circulating fluid volume status and to monitor for complications.