Which of the following tests is most commonly used to diagnose cholecystitis?
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Solution
Abdominal ultrasound
An abdominal ultrasound can show if the gallbladder is enlarged, if gallstones are present, if the gallbladder wall is thickened, or if distention of the gallbladder lumen is present. An abdominal CT scan can be used to diagnose cholecystitis, but it usually isn’t necessary. A barium swallow looks at the stomach and the duodenum. Endoscopy looks at the esophagus, stomach, and duodenum.
Which of the following symptoms best describes Murphy’s sign?
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Solution
On deep inspiration, pain is elicited and breathing stops
Murphy’s sign is elicited when the client reacts to pain and stops breathing. It’s a common finding in clients with cholecystitis. Periumbilical ecchymosis, Cullen’s sign, is present in peritonitis. Pain on deep palpation and release is rebound tenderness. Tightening up abdominal muscles in anticipation of palpation is guarding.
When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important?
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Solution
Keep weight proportionate to height
Obesity is a known cause of gallstones, and maintaining a recommended weight will help protect against gallstones. Excessive dietary intake of cholesterol is associated with the development of gallstones in many people. Dietary protein isn’t implicated in cholecystitis. Liquid protein and low-calorie diets (with rapid weight loss of more than 5 lb [2.3kg] per week) are implicated as the cause of some cases of cholecystitis. Regular exercise (30 minutes/three times a week) may help reduce weight and improve fat metabolism. Reducing stress may reduce bile production, which may also indirectly decrease the chances of developing cholecystitis.
Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications?
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Solution
To stimulate mucus production
The mucosal barrier fortifiers stimulate mucus production and prevent hydrogen ion diffusion back into the mucosa, resulting in accelerated ulcer healing. Antacids neutralize acid production.
If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client?
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Solution
Antacid administration
Antacids aren’t helpful in perforation. The client should be treated with antibiotics as well as fluid, electrolyte, and blood replacement. NG tube suction should also be performed to prevent further spillage of stomach contents into the peritoneal cavity.
Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection?
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Solution
Monitoring for symptoms of hemorrhage
The client should be monitored closely for signs and symptoms of hemorrhage, such as bright red blood in the nasogastric tube suction, tachycardia, or a drop in blood pressure. Gastric pH may be monitored to evaluate the need for histamine-2 receptor antagonists. Bowel sounds may not return for up to 72 hours postoperatively. Nutritional needs should be addressed soon after surgery.
The nurse would assess the client experiencing an acute episode of cholecystitis for pain that is located in the right
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Solution
Upper quadrant and radiates to the right scapula and shoulder
During an acute “gallbladder attack,” the client may complain of severe right upper quadrant pain that radiates to the right scapula and shoulder. This is governed by the pattern on dermatomes in the body.
A client with a peptic ulcer is scheduled for a vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure:
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Solution
Reduces the stimulus to acid secretions
A vagotomy, or cutting the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion.
The client with peptic ulcer disease is scheduled for a pyloroplasty. The client asks the nurse about the procedure. The nurse plans to respond knowing that a pyloroplasty involves:
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Solution
An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.
Option 4 describes the procedure for a pyloroplasty. A vagotomy involves cutting the vagus nerve. A subtotal gastrectomy involves removing the distal portion of the stomach. A Billroth II procedure involves removal of the ulcer and a large portion of the tissue that produces hydrochloric acid.
The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates the best understanding of the medication therapy?
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Solution
“The cimetidine (Tagamet) will cause me to produce less stomach acid.”
Cimetidine (Tagamet), a histamine H2 receptor antagonist, will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.