Galen medsurg exam #4 with correct |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
answers
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. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
answers
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
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mass. Pancreatitis is characterized by severe pain. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The nurse practitioner is performing an abdominal assessment on a newly admitted client. In
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which order should the nurse proceed with assessment technique?
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|||\\\ Auscultation, percussion, palpation, inspection |||\\\ |||\\\ |||\\\
|||\\\ Inspection, auscultation, percussion, palpation |||\\\ |||\\\ |||\\\ |||\\\
|||\\\ Palpation, percussion, inspection, auscultation |||\\\ |||\\\ |||\\\
Percussion, auscultation, palpation, inspection - correct answer✔✔The abdomen is assessed
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by using the four techniques of examination, but in a sequence different from that used for
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other body systems: inspection, auscultation, percussion, and then palpation. This sequence is
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preferred so that palpation and percussion do not increase intestinal activity and bowel |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
sounds. Nurse generalists may perform inspection, auscultation, and light palpation; percussion
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and deep palpation may be done by advanced practice nurses.
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A client with gastroesophageal reflux disease (GERD) is prescribed to start pantoprazole
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(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."
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, B. "I'll take this drug at 8 AM every morning."
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C. "This drug can cause headache and dizziness."
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D. "I should not crush the drug because it has a delayed release." - correct answer✔✔Answer:
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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
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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
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of the gastric parietal cells. This medication should not be crushed because of its delayed
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release properties. |||\\\
Over the past 3 months, a client with a history of gastroesophageal reflux disease and obesity
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has implemented lifestyle changes. What lifestyle changes does the nurse recognize as
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important for the client to decrease chances of development of cancer of the esophagus? |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Select all that apply. |||\\\ |||\\\ |||\\\
A. Lost 10 pounds
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B. Sleeps with two pillows
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C. Has quit eating processed foods
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D. Drinks a glass of wine every night
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E. Uses a nicotine patch instead of smoking - correct answer✔✔Answer: A, B, C, E
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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
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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,
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can contribute to an increased risk for esophageal (and other types of) cancer. Excessive
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alcohol intake is associated with esophageal cancer. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
