Galen med surg exam 4 with verified solutions
A |client |is |provided |with |materials |to |obtain |three |fecal |occult |blood |tests |(Hemoccult). |What
|health |teaching |does |the |nurse |provide? |Select |all |that |apply.
A. |"Avoid |red |meat |and |raw |vegetables |for |a |week |before |getting |the |samples."
B. |"Drink |a |gallon |of |GoLYTELY |before |you |collect |the |first |sample."
C. |"Do |not |take |food |or |fluids |for |24 |hours |before |the |test."
D. |"Do |not |take |ibuprofen |for |a |week |before |obtaining |the |samples."
E. |"Avoid |vitamin |C |tablets, |foods, |and |juices |a |week |before |getting |the |samples." |- |correct |answer
|-Answer: |A, |D, |E
Rationale: |To |avoid |obtaining |false-positive |results |associated |with |fecal |occult |blood |tests
|(Hemoccult), |patients |must |avoid |certain |foods |before |the |test, |such |as |raw |fruits |and |vegetables
|and |red |meat. |Vitamin |C-rich |foods, |juices, |and |tablets |must |also |be |avoided. |Anticoagulants, |such
|as |warfarin |(Coumadin), |and |nonsteroidal |antiinflammatory |drugs |should |be |discontinued |for |7
|days |before |testing |begins.
What |is |a |common |gastrointestinal |problem |that |older |adults |experience |more |frequently |as |they
|age?
| Decreased |hydrochloric |acid |
| Excess |lipase |production
| Increased |liver |enzymes
|Increased |peristalsis |- |correct |answer |-Atrophy |of |the |gastric |mucosa |causes |a |decreased |ratio |of
|gastrin-secreting |cells |to |somatostatin-secreting |cells. |This |results |in |a |decrease |in |hydrochloric
|acid, |causing |decreased |absorption |of |iron |and |vitamin |B12. |In |the |pancreas, |calcification |of
|pancreatic |vessels |occurs, |with |a |decrease |in |lipase |production. |The |decrease |in |lipase |results |in
|decreased |fat |absorption |and |digestion. |Steatorrhea |and |diarrhea |can |subsequently |occur. |The
|number |and |size |of |hepatic |cells |are |decreased, |which |results |in |decreased |enzyme |activity;
|decreased |liver |enzyme |activity |depresses |drug |metabolism, |and |therefore |may |cause
|accumulation |of |drugs |to |toxic |levels. |In |the |large |intestine, |peristalsis |is |decreased |and |nerve
|impulses |are |dulled, |which |can |result |in |postponement |of |bowel |movements |in |older |adults.
A |client |is |admitted |to |the |hospital |with |severe |right |upper |quadrant |(RUQ) |abdominal |pain. |Which
|assessment |technique |does |the |nurse |use |for |this |client?
,| Assesses |the |abdomen |in |the |following |sequence: |inspection, |palpation, |percussion, |auscultation
| Examines |the |RUQ |of |the |abdomen |last |
|Has |the |client |lie |in |a |supine |position |with |legs |straight |and |arms |at |the |sides |- |correct |answer |-
Views |the |abdomen |by |looking |directly |down |while |standing |over |the |client's |abdominal |area
cussion, |and |then |palpation. |This |sequence |prevents |the |increase |in |intestinal |activity |and |bowel
|sounds |caused |by |palpation |and |percussion. |The |client |would |be |positioned |supine |with |the |knees
|bent, |while |keeping |the |arms |at |the |sides |to |prevent |tensing |of |the |abdominal |muscles. |It |is |best
|to |inspect |the |abdomen |by |sIf |the |client |reports |pain |in |the |RUQ, |the |nurse |would |examine |this
|area |last |in |the |examination |sequence. |This |sequence |prevents |the |client |from |tensing |abdominal
|muscles |because |of |the |pain, |which |would |make |the |examination |difficult. |The |sequence |for
|examining |the |abdomen |is |inspection, |auscultation, |pertanding |at |the |side |of |the |bed |and |then
|looking |down |on |the |abdomen, |and |also |from |the |side |at |eye |level.
A |client |is |admitted |to |the |hospital |with |elevated |serum |amylase |and |lipase |levels |and |a |decreased
|calcium |level. |Which |gastrointestinal |health |problem |is |indicated |by |these |laboratory |findings?
| Acute |pancreatitis |
| Cirrhosis
| Crohn's |disease
|Diarrhea |- |correct |answer |-These |laboratory |values |are |commonly |found |in |clients |with |acute
|pancreatitis. |They |are |not |indicative |of |cirrhosis |of |the |liver |or |Crohn's |disease. |These |laboratory
|values |are |not |found |in |a |client |with |diarrhea.
The |nurse |is |assessing |a |client |who |has |come |to |the |emergency |department |with |acute |abdominal
|pain. |The |client |is |very |thin |and |the |nurse |observes |visible |peristaltic |movements |when |inspecting
|the |abdomen. |What |does |the |nurse |suspect?
| Acute |diarrhea
| Aortic |aneurysm
| Intestinal |obstruction |
|Pancreatitis |- |correct |answer |-Peristaltic |movements |are |rarely |seen |except |in |thin |clients |and
|should |be |reported |since |the |finding |may |indicate |an |intestinal |obstruction. |Acute |diarrhea |does
|not |cause |visible |peristaltic |movements. |Aortic |aneurysm |may |cause |a |bulging, |pulsatile |mass.
|Pancreatitis |is |characterized |by |severe |pain.
The |nurse |practitioner |is |performing |an |abdominal |assessment |on |a |newly |admitted |client. |In
|which |order |should |the |nurse |proceed |with |assessment |technique?
,| Auscultation, |percussion, |palpation, |inspection
| Inspection, |auscultation, |percussion, |palpation |
| Palpation, |percussion, |inspection, |auscultation
|Percussion, |auscultation, |palpation, |inspection |- |correct |answer |-The |abdomen |is |assessed |by |using
|the |four |techniques |of |examination, |but |in |a |sequence |different |from |that |used |for |other |body
|systems: |inspection, |auscultation, |percussion, |and |then |palpation. |This |sequence |is |preferred |so
|that |palpation |and |percussion |do |not |increase |intestinal |activity |and |bowel |sounds. |Nurse
|generalists |may |perform |inspection, |auscultation, |and |light |palpation; |percussion |and |deep
|palpation |may |be |done |by |advanced |practice |nurses.
A |client |with |gastroesophageal |reflux |disease |(GERD) |is |prescribed |to |start |pantoprazole |(Protonix)
|40 |mg |every |day. |Which |statement |by |the |client |requires |further |teaching |by |the |nurse?
A. |"When |I |feel |better, |I |can |stop |taking |this |drug." |
B. |"I'll |take |this |drug |at |8 |AM |every |morning."
C. |"This |drug |can |cause |headache |and |dizziness."
D. |"I |should |not |crush |the |drug |because |it |has |a |delayed |release." |- |correct |answer |-Answer: |A
Rationale: |Treatment |for |GERD |should |be |continued |even |if |a |client |begins |to |feel |better.
|Discontinuation |of |therapy |can |result |in |return |of |original |GERD |symptoms, |which |can |further
|damage |esophageal |tissues. |Side |effects |of |pantoprazole |(Protonix) |can |include |headache |and
|dizziness, |which |should |immediately |be |reported |to |the |client's |health |care |provider. |This
|medication |should |be |taken |on |a |regular, |predictable |schedule |because |proton |pump |inhibitors
|provide |effective, |long-acting |inhibition |of |gastric |acid |secretion |by |affecting |the |proton |pump |of
|the |gastric |parietal |cells. |This |medication |should |not |be |crushed |because |of |its |delayed |release
|properties.
Over |the |past |3 |months, |a |client |with |a |history |of |gastroesophageal |reflux |disease |and |obesity |has
|implemented |lifestyle |changes. |What |lifestyle |changes |does |the |nurse |recognize |as |important |for
|the |client |to |decrease |chances |of |development |of |cancer |of |the |esophagus? |Select |all |that |apply.
A. |Lost |10 |pounds
B. |Sleeps |with |two |pillows
C. |Has |quit |eating |processed |foods
D. |Drinks |a |glass |of |wine |every |night
E. |Uses |a |nicotine |patch |instead |of |smoking |- |correct |answer |-Answer: |A, |B, |C, |E
, Rationale: |Losing |weight |can |result |in |a |decrease |in |intra-abdominal |pressure, |which |can |reduce |the
|symptoms |of |reflux |that |are |associated |with |an |increased |risk |for |development |of |esophageal
|cancer. |Nocturnal |reflux |can |be |reduced |by |sleeping |with |the |head |of |the |bed |elevated |or |with |the
|use |of |two |pillows. |Chemicals |used |in |processed |foods, |as |well |as |smoking, |can |contribute |to |an
|increased |risk |for |esophageal |(and |other |types |of) |cancer. |Excessive |alcohol |intake |is |associated
|with |esophageal |cancer.
The |nurse |prepares |a |teaching |session |regarding |lifestyle |changes |needed |to |decrease |the
|discomfort |associated |with |a |client's |hiatal |hernia. |Which |change |does |the |nurse |recommend |to
|this |client?
| Eat |only |two |or |three |meals |daily.
| Sleep |flat |in |a |left |side-lying |position.
| Drink |tea |instead |of |coffee.
|Avoid |working |while |bent |over |the |computer. |- |correct |answer |-The |client |should |avoid |working
|while |bent |over |because |this |position |presses |on |the |diaphragm, |causing |discomfort. |The |client
|with |a |hiatal |hernia |should |eat |four |to |six |meals |a |day. |The |head |of |the |client's |bed |should |be
|elevated |approximately |6 |inches. |Both |tea |and |coffee |should |be |eliminated |from |this |client's |diet
|because |of |the |caffeine |content.
The |nurse |is |reinforcing |the |instructions |on |swallowing |provided |by |the |speech-language
|pathologist |to |a |client |diagnosed |with |esophageal |cancer. |Which |instruction |to |the |client |is |the
|highest |priority?
| Place |food |at |the |back |of |the |mouth |as |you |eat. |
| Do |not |be |overly |concerned |with |tongue |or |lip |movements.
| Before |swallowing, |tilt |the |head |back |to |straighten |the |esophagus. |
|Do |not |attempt |to |reach |food |particles |that |are |on |the |lips |or |around |the |mouth. |- |correct |answer
|-Placing |food |at |the |back |of |the |mouth |when |eating |will |help |the |client |avoid |aspirating. |Both
|tongue |movements |and |sealing |of |the |lips |should |be |monitored |in |this |client. |The |client's |head
|should |be |tilted |forward |in |the |chin-tuck |position. |The |client |should |be |able |to |reach |food |particles
|on |her |or |his |lips |and |around |the |mouth |with |the |tongue.
A |client |has |undergone |conventional |esophageal |surgery. |The |client's |diet |has |been |advanced |to
|semi-solid, |and |feedings |are |well |tolerated. |The |client |reports |experiencing |diarrhea |about |1 |hour
|after |each |meal. |What |is |the |priority |nursing |intervention |to |help |prevent |further |diarrhea?
A |client |is |provided |with |materials |to |obtain |three |fecal |occult |blood |tests |(Hemoccult). |What
|health |teaching |does |the |nurse |provide? |Select |all |that |apply.
A. |"Avoid |red |meat |and |raw |vegetables |for |a |week |before |getting |the |samples."
B. |"Drink |a |gallon |of |GoLYTELY |before |you |collect |the |first |sample."
C. |"Do |not |take |food |or |fluids |for |24 |hours |before |the |test."
D. |"Do |not |take |ibuprofen |for |a |week |before |obtaining |the |samples."
E. |"Avoid |vitamin |C |tablets, |foods, |and |juices |a |week |before |getting |the |samples." |- |correct |answer
|-Answer: |A, |D, |E
Rationale: |To |avoid |obtaining |false-positive |results |associated |with |fecal |occult |blood |tests
|(Hemoccult), |patients |must |avoid |certain |foods |before |the |test, |such |as |raw |fruits |and |vegetables
|and |red |meat. |Vitamin |C-rich |foods, |juices, |and |tablets |must |also |be |avoided. |Anticoagulants, |such
|as |warfarin |(Coumadin), |and |nonsteroidal |antiinflammatory |drugs |should |be |discontinued |for |7
|days |before |testing |begins.
What |is |a |common |gastrointestinal |problem |that |older |adults |experience |more |frequently |as |they
|age?
| Decreased |hydrochloric |acid |
| Excess |lipase |production
| Increased |liver |enzymes
|Increased |peristalsis |- |correct |answer |-Atrophy |of |the |gastric |mucosa |causes |a |decreased |ratio |of
|gastrin-secreting |cells |to |somatostatin-secreting |cells. |This |results |in |a |decrease |in |hydrochloric
|acid, |causing |decreased |absorption |of |iron |and |vitamin |B12. |In |the |pancreas, |calcification |of
|pancreatic |vessels |occurs, |with |a |decrease |in |lipase |production. |The |decrease |in |lipase |results |in
|decreased |fat |absorption |and |digestion. |Steatorrhea |and |diarrhea |can |subsequently |occur. |The
|number |and |size |of |hepatic |cells |are |decreased, |which |results |in |decreased |enzyme |activity;
|decreased |liver |enzyme |activity |depresses |drug |metabolism, |and |therefore |may |cause
|accumulation |of |drugs |to |toxic |levels. |In |the |large |intestine, |peristalsis |is |decreased |and |nerve
|impulses |are |dulled, |which |can |result |in |postponement |of |bowel |movements |in |older |adults.
A |client |is |admitted |to |the |hospital |with |severe |right |upper |quadrant |(RUQ) |abdominal |pain. |Which
|assessment |technique |does |the |nurse |use |for |this |client?
,| Assesses |the |abdomen |in |the |following |sequence: |inspection, |palpation, |percussion, |auscultation
| Examines |the |RUQ |of |the |abdomen |last |
|Has |the |client |lie |in |a |supine |position |with |legs |straight |and |arms |at |the |sides |- |correct |answer |-
Views |the |abdomen |by |looking |directly |down |while |standing |over |the |client's |abdominal |area
cussion, |and |then |palpation. |This |sequence |prevents |the |increase |in |intestinal |activity |and |bowel
|sounds |caused |by |palpation |and |percussion. |The |client |would |be |positioned |supine |with |the |knees
|bent, |while |keeping |the |arms |at |the |sides |to |prevent |tensing |of |the |abdominal |muscles. |It |is |best
|to |inspect |the |abdomen |by |sIf |the |client |reports |pain |in |the |RUQ, |the |nurse |would |examine |this
|area |last |in |the |examination |sequence. |This |sequence |prevents |the |client |from |tensing |abdominal
|muscles |because |of |the |pain, |which |would |make |the |examination |difficult. |The |sequence |for
|examining |the |abdomen |is |inspection, |auscultation, |pertanding |at |the |side |of |the |bed |and |then
|looking |down |on |the |abdomen, |and |also |from |the |side |at |eye |level.
A |client |is |admitted |to |the |hospital |with |elevated |serum |amylase |and |lipase |levels |and |a |decreased
|calcium |level. |Which |gastrointestinal |health |problem |is |indicated |by |these |laboratory |findings?
| Acute |pancreatitis |
| Cirrhosis
| Crohn's |disease
|Diarrhea |- |correct |answer |-These |laboratory |values |are |commonly |found |in |clients |with |acute
|pancreatitis. |They |are |not |indicative |of |cirrhosis |of |the |liver |or |Crohn's |disease. |These |laboratory
|values |are |not |found |in |a |client |with |diarrhea.
The |nurse |is |assessing |a |client |who |has |come |to |the |emergency |department |with |acute |abdominal
|pain. |The |client |is |very |thin |and |the |nurse |observes |visible |peristaltic |movements |when |inspecting
|the |abdomen. |What |does |the |nurse |suspect?
| Acute |diarrhea
| Aortic |aneurysm
| Intestinal |obstruction |
|Pancreatitis |- |correct |answer |-Peristaltic |movements |are |rarely |seen |except |in |thin |clients |and
|should |be |reported |since |the |finding |may |indicate |an |intestinal |obstruction. |Acute |diarrhea |does
|not |cause |visible |peristaltic |movements. |Aortic |aneurysm |may |cause |a |bulging, |pulsatile |mass.
|Pancreatitis |is |characterized |by |severe |pain.
The |nurse |practitioner |is |performing |an |abdominal |assessment |on |a |newly |admitted |client. |In
|which |order |should |the |nurse |proceed |with |assessment |technique?
,| Auscultation, |percussion, |palpation, |inspection
| Inspection, |auscultation, |percussion, |palpation |
| Palpation, |percussion, |inspection, |auscultation
|Percussion, |auscultation, |palpation, |inspection |- |correct |answer |-The |abdomen |is |assessed |by |using
|the |four |techniques |of |examination, |but |in |a |sequence |different |from |that |used |for |other |body
|systems: |inspection, |auscultation, |percussion, |and |then |palpation. |This |sequence |is |preferred |so
|that |palpation |and |percussion |do |not |increase |intestinal |activity |and |bowel |sounds. |Nurse
|generalists |may |perform |inspection, |auscultation, |and |light |palpation; |percussion |and |deep
|palpation |may |be |done |by |advanced |practice |nurses.
A |client |with |gastroesophageal |reflux |disease |(GERD) |is |prescribed |to |start |pantoprazole |(Protonix)
|40 |mg |every |day. |Which |statement |by |the |client |requires |further |teaching |by |the |nurse?
A. |"When |I |feel |better, |I |can |stop |taking |this |drug." |
B. |"I'll |take |this |drug |at |8 |AM |every |morning."
C. |"This |drug |can |cause |headache |and |dizziness."
D. |"I |should |not |crush |the |drug |because |it |has |a |delayed |release." |- |correct |answer |-Answer: |A
Rationale: |Treatment |for |GERD |should |be |continued |even |if |a |client |begins |to |feel |better.
|Discontinuation |of |therapy |can |result |in |return |of |original |GERD |symptoms, |which |can |further
|damage |esophageal |tissues. |Side |effects |of |pantoprazole |(Protonix) |can |include |headache |and
|dizziness, |which |should |immediately |be |reported |to |the |client's |health |care |provider. |This
|medication |should |be |taken |on |a |regular, |predictable |schedule |because |proton |pump |inhibitors
|provide |effective, |long-acting |inhibition |of |gastric |acid |secretion |by |affecting |the |proton |pump |of
|the |gastric |parietal |cells. |This |medication |should |not |be |crushed |because |of |its |delayed |release
|properties.
Over |the |past |3 |months, |a |client |with |a |history |of |gastroesophageal |reflux |disease |and |obesity |has
|implemented |lifestyle |changes. |What |lifestyle |changes |does |the |nurse |recognize |as |important |for
|the |client |to |decrease |chances |of |development |of |cancer |of |the |esophagus? |Select |all |that |apply.
A. |Lost |10 |pounds
B. |Sleeps |with |two |pillows
C. |Has |quit |eating |processed |foods
D. |Drinks |a |glass |of |wine |every |night
E. |Uses |a |nicotine |patch |instead |of |smoking |- |correct |answer |-Answer: |A, |B, |C, |E
, Rationale: |Losing |weight |can |result |in |a |decrease |in |intra-abdominal |pressure, |which |can |reduce |the
|symptoms |of |reflux |that |are |associated |with |an |increased |risk |for |development |of |esophageal
|cancer. |Nocturnal |reflux |can |be |reduced |by |sleeping |with |the |head |of |the |bed |elevated |or |with |the
|use |of |two |pillows. |Chemicals |used |in |processed |foods, |as |well |as |smoking, |can |contribute |to |an
|increased |risk |for |esophageal |(and |other |types |of) |cancer. |Excessive |alcohol |intake |is |associated
|with |esophageal |cancer.
The |nurse |prepares |a |teaching |session |regarding |lifestyle |changes |needed |to |decrease |the
|discomfort |associated |with |a |client's |hiatal |hernia. |Which |change |does |the |nurse |recommend |to
|this |client?
| Eat |only |two |or |three |meals |daily.
| Sleep |flat |in |a |left |side-lying |position.
| Drink |tea |instead |of |coffee.
|Avoid |working |while |bent |over |the |computer. |- |correct |answer |-The |client |should |avoid |working
|while |bent |over |because |this |position |presses |on |the |diaphragm, |causing |discomfort. |The |client
|with |a |hiatal |hernia |should |eat |four |to |six |meals |a |day. |The |head |of |the |client's |bed |should |be
|elevated |approximately |6 |inches. |Both |tea |and |coffee |should |be |eliminated |from |this |client's |diet
|because |of |the |caffeine |content.
The |nurse |is |reinforcing |the |instructions |on |swallowing |provided |by |the |speech-language
|pathologist |to |a |client |diagnosed |with |esophageal |cancer. |Which |instruction |to |the |client |is |the
|highest |priority?
| Place |food |at |the |back |of |the |mouth |as |you |eat. |
| Do |not |be |overly |concerned |with |tongue |or |lip |movements.
| Before |swallowing, |tilt |the |head |back |to |straighten |the |esophagus. |
|Do |not |attempt |to |reach |food |particles |that |are |on |the |lips |or |around |the |mouth. |- |correct |answer
|-Placing |food |at |the |back |of |the |mouth |when |eating |will |help |the |client |avoid |aspirating. |Both
|tongue |movements |and |sealing |of |the |lips |should |be |monitored |in |this |client. |The |client's |head
|should |be |tilted |forward |in |the |chin-tuck |position. |The |client |should |be |able |to |reach |food |particles
|on |her |or |his |lips |and |around |the |mouth |with |the |tongue.
A |client |has |undergone |conventional |esophageal |surgery. |The |client's |diet |has |been |advanced |to
|semi-solid, |and |feedings |are |well |tolerated. |The |client |reports |experiencing |diarrhea |about |1 |hour
|after |each |meal. |What |is |the |priority |nursing |intervention |to |help |prevent |further |diarrhea?
