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The nurse is preparing to administer amitriptyline 10 mg orally to the client diagnosed with IBS. The client asks, “Why am I receiving this? I don’t feel depressed.” Which response by the nurse is best?
- A. “The medication is working. People with chronic diseases typically also suffer from depression.”
- B. “People with IBS have difficulty returning to sleep after waking to the bathroom. It will help you get adequate rest.”
- C. “The anticholinergic side effects of the drug will help to prevent bowel irritability and constipation.”
- D. “Tricyclic antidepressants reduce abdominal pain by affecting the communication system from the bowel to the brain.”
Correct Answer: D
Rationale: A. Not all clients with chronic diseases suffer from depression. The response does not address the primary reason for the use of a TCA such as amitriptyline (Elavil) in IBS. B. A common response to TCAs is sedation; however, this medication is not given for this reason. C. TCAs do have anticholinergic side effects and can cause (not prevent) constipation. Clients with IBS can have constipation or diarrhea. D. Evidence supports that TCAs can reduce abdominal pain, and this benefit is unrelated to whether or not the client is being treated for depression.
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The nurse is caring for the client diagnosed with hemorrhoids. Which statement indicates further teaching is needed?
- A. I should increase fruits, bran, and fluids in my diet.
- B. I will use warm compresses and take sitz baths daily.
- C. I must take a laxative every night and have a stool daily.
- D. I can use an analgesic ointment or suppository for pain.
Correct Answer: C
Rationale: Daily laxatives are not necessary and may cause dependency; hemorrhoid management focuses on diet and symptom relief. Increased fiber/fluids, sitz baths, and analgesics are correct.
The client tells the nurse about being diagnosed with a 2-cm cancerous tumor in the liver. The client wants to know about the treatment. Which statement should be the basis for the nurse’s response?
- A. The use of chemotherapy is the first-line treatment for liver cancer.
- B. Liver transplantation is not an option for clients with liver cancer.
- C. Radiofrequency ablation can be successful in treating tumors of this size.
- D. A tumor of this size can only be removed through an open surgical approach.
Correct Answer: C
Rationale: A. Chemotherapy is only used for clients who are not likely to benefit from other therapies. B. Liver transplantation is used when the tumor is large or localized. C. Radiofrequency ablation is a treatment technique that uses high-frequency alternating electrical current to heat tissue cells and destroy them. It can be successfully used to treat tumors less than 5 cm in size because these tumors tend to be slow growing and encapsulated. D. Surgical resection of the tumor is used when the tumor is large or localized.
The postanesthesia care nurse is caring for a client who had abdominal surgery and is complaining of nausea. Which intervention should the nurse implement first?
- A. Medicate the client with a narcotic analgesic (IVP).
- B. Assess the nasogastric tube for patency.
- C. Check the temperature for elevation.
- D. Hyperextend the neck to prevent stridor.
Correct Answer: B
Rationale: Assessing NG tube patency ensures it is functioning to prevent nausea from gastric distension. Narcotics may worsen nausea, fever is secondary, and neck hyperextension is irrelevant.
Which statement made by the client indicates to the nurse the client may be experiencing GERD?
- A. My chest hurts when I walk up the stairs in my home.
- B. I take antacid tablets with me wherever I go.
- C. My spouse tells me I snore very loudly at night.
- D. I drink six (6) to seven (7) soft drinks every day.
Correct Answer: B
Rationale: Frequent use of antacids suggests ongoing heartburn or reflux symptoms, a hallmark of GERD. Chest pain with exertion is more suggestive of cardiac issues, snoring may indicate sleep apnea, and soft drink consumption is a risk factor but not a direct symptom.
The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented?
- A. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications.
- B. Have the client remain upright at all times and walk for 30 minutes three (3) times a week.
- C. Instruct the client to maintain a right lateral side-lying position and take antacids before meals.
- D. Elevate the head of the bed (HOB) 30 degrees and discuss lifestyle modifications with the client.
Correct Answer: D
Rationale: Elevating the head of the bed prevents reflux during sleep, and lifestyle modifications (e.g., avoiding trigger foods, not lying down after meals) are key to managing GERD. Prone positioning worsens reflux, remaining upright at all times is impractical, and right lateral positioning is less effective than head elevation.