Reason:Metoclopramide hydrochloride (Reglan) increases esophageal sphincter tone and facilitates gastric emptying; both actions reduce the incidence of refl ux. Other drugs, such as antacids or histamine receptor antagonists, may also be prescribed to help control refl ux and esophagitis and to decrease or neutralize gastric secretions. Reglan is not effective in decreasing or neutralizing gastric secretions.
02. Answer C.
Reason:The magnesium salts in magnesium hydroxide are related to those found in laxatives and may cause diarrhea. Aluminum salt products
can cause constipation. Many clients find that a combination product is required to maintain normal bowel elimination. The use of magnesium hydroxide does not cause anorexia or weight gain.
03.Answer A.
Reason:Heartburn, the most common symptom of a sliding hiatal hernia, results from refl ux of gastric secretions into the esophagus. Regurgitation of gastric contents and dysphagia are other common symptoms.
Jaundice, which results from a high concentration of bilirubin in the blood, is not associated with hiatal hernia. Anorexia is not a typical symptom of hiatal hernia. Stomatitis is infl ammation of the mouth.
04. AnswerA.
Reason:Clients who have had gastric surgery are prone to postoperative complications, such as dumping syndrome and postprandial hypoglycemia,that can affect nutritional intake. Vitamin absorption
can also be an issue, depending on the extent of the gastric surgery. Radiation therapy to the upper gastrointestinal area also can affect nutritional intake by causing anorexia, nausea, and esophagitis.
The client would not be expected to develop alopecia.Exercise and activity levels as well as access to community resources are important teaching areas,but nutritional intake is a priority need.
05. Answer C.
Reason: With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal
sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages,peppermint, and alcohol. A diet high in protein and
low in fat is recommended for clients with GERD.Lean beef, popcorn, and raw vegetables would be acceptable.
06. Answer C.
Reason: A client who has had abdominal surgery is best placed in a low Fowler’s position postoperatively.This positioning relaxes abdominal muscles and provides for maximum respiratory and cardiovascular
function. The prone, supine, or Sims position would not be tolerated by a client who has had abdominal surgery, nor do those positions support
respiratory or cardiovascular functioning.
07. Answer A.
Reason:About 12 to 24 hours after a subtotal gastrectomy, gastric drainage is normally brown, which indicates digested blood. Bile green or cloudy white drainage is not expected during the first 12
to 24 hours after a subtotal gastrectomy. Drainage during the fi rst 6 to 12 hours contains some bright red blood, but large amounts of blood or excessive bloody drainage should be reported to the physician
promptly.
08. Answer C.
Reason:The most likely complication of an endoscopic procedure is perforation. A sudden temperature spike within 1 to 2 hours after the procedure is indicative of a perforation and should be reported
immediately to the physician. A sore throat is to be anticipated after an endoscopy. Clients are given sedatives during the procedure, so it is expected that they will display signs of sedation after the procedure
is completed. A lack of appetite could be the result of many factors, including the disease process.
09.Answer C.
Reason: Diet therapy for ulcer disease is a controversial issue. There is no scientifi cevidence that diet therapy promotes healing. Most clients
are instructed to follow a diet that they can tolerate.
There is no need for the client to ingest only a bland or high-protein diet. Milk may be included in the diet, but it is not recommended in excessive amounts.
10.Answer D.
Reason: The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in boardlike abdominal rigidity, usually with extreme pain. Perforation is a medical emergency
requiring immediate surgical intervention because peritonitis develops quickly after perforation. An intestinal obstruction would not cause midepigastric pain. The development of additional ulcers or
esophageal infl ammation would not cause a rigid,boardlike abdomen.
11.Answer C.
Reason: The nurse’s fi rst action is to clear the client’s airway as necessary. Inserting an NG tube or administering an antiemetic may prevent future vomiting episodes, but these procedures are not helpful when the client is actually vomiting. Cutting the wires is done only as a last resort or in case ofrespiratory or cardiac arrest.
12. Answer B.
Reason:The priority of care in the immediate postoperative phase is to maintain a patent airway. The nurse should observe the client carefully for signs of respiratory distress. If the client becomes nauseated,
antiemetics should be administered to decrease the chance of vomiting with obstruction of the airway and aspiration of vomitus. Providing frequent oral hygiene and an alternative means of communication
are important aspects of nursing care, but maintaining a patent airway is most important.
13. Answer B, D.
Reason: Following surgery for a fractured mandible,the client’s jaws will be wired. The nurse should be prepared to intervene quickly in case the client develops respiratory distress or begins to choke or vomit.
Wire cutters or scissors should always be available in case the wires need to be cut in a medical emergency. Suction equipment should be available to help clear the client’s airway if necessary.
It is not necessary to keep a nasogastric tube or oxygen cannula at the client’s bedside. Cardiopulmonary arrest is unlikely, so a code cart is not needed at the bedside.
14.Answer: C
Reason: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked,the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.
15.Answer C
Reason: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery.
16.Answer A
Reason: An unconscious client is best positioned in a lateral or semiprone position because these positions allow the jaw and tongue to fall forward,facilitate drainage of secretions, and prevent aspiration. Positioning the client supine carries a major risk of airway obstruction from the tongue,vomitus, or nasopharyngeal secretions. Trendelenburg's position, with the head lower than the heart, decreases effective lung volume and increases the risk of cerebral edema. The lithotomy position has no purpose in this situation.
17.AnswerB
Reason: The nurse must continue enteric precautions for a client with gastroenteritis caused by the Norwalk virus because this virus is transmitted by the fecal-oral route. No safe and effective antiviral agent is available specifically for treating viral gastroenteritis. The Norwalk virus isn't transmitted by droplets.
18.Answer B
Reason: The TPN solution is usually a hypertonic dextrose solution. The greater the concentration of dextrose in solution, the greater the tonicity. Hypertonic dextrose solutions are used to meet the body's calorie demands in a volume of fluid that will not overload the cardiovascular system. An isotonic dextrose solution (e.g., 5% dextrose in water) or a hypotonic dextrose solution will not provide enough calories to meet metabolic needs.Colloids are plasma expanders and blood products and are not used in TPN.
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