A 40-year-old male client has been hospitalized with peptic ulcer disease. He is being treated with a histamine receptor antagonist (cimetidine), antacids, and diet. The nurse doing discharge planning will teach him that the action of cimetidine is to:
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Solution
Reduce gastric acid output
These drugs inhibit the action of histamine on the H2 receptors of parietal cells, thus reducing gastric acid output.
When a client has peptic ulcer disease, the nurse would expect a priority intervention to be:
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Solution
Inserting a nasogastric tube
An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. A Miller-Abbott tube (1) is a weighted, mercury-filled ballooned tube used to resolve bowel obstructions. There is no evidence of shock or fluid overload in the client; therefore, an arterial line (2) is not appropriate at this time and an IV (4) is optional.
A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out:
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Solution
Peptic ulcer disease
Peptic ulcer disease is characteristically gnawing epigastric pain that may radiate to the back. Vomiting usually reflects pyloric spasm from muscular spasm or obstruction. Cancer (1) would not evidence pain or vomiting unless the pylorus was obstructed.
The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to:
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Solution
Regularly assess respiratory status
The respiratory system can become occluded if the balloon slips and moves up the esophagus, putting pressure on the trachea. This would result in respiratory distress and should be assessed frequently. Scissors should be kept at the bedside to cut the tube if distress occurs. This is a safety intervention.
The most important pathophysiologic factor contributing to the formation of esophageal varices is:
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Solution
Portal hypertension
As the liver cells become fatty and degenerate, they are no longer able to accommodate a large amount of blood necessary for homeostasis. The pressure in the liver increases and causes increased pressure in the venous system. As the portal pressure increases, fluid exudes into the abdominal cavity. This is called ascites.
The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that will assist in the insertion would be:
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Solution
Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion
NG insertion technique is to have the client first tilt his head back for insertion into the nostril, then to flex his neck forward and swallow. Extension of the neck (2) will impede NG tube insertion.
The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics?
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Solution
Pain on empty stomach
Pain on empty stomach is relieved by taking foods or antacids. The other symptoms are those of a gastric ulcer.
The client with a duodenal ulcer may exhibit which of the following findings on assessment?
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Solution
Melena
The client with a duodenal ulcer may have bleeding at the ulcer site, which shows up as melena (black tarry stool). The other findings are consistent with a gastric ulcer.
A client being treated for chronic cholecystitis should be given which of the following instructions?
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Solution
Use anticholinergics as prescribed
Conservative therapy for chronic cholecystitis includes weight reduction by increasing physical activity, a low-fat diet, antacid use to treat dyspepsia, and anticholinergic use to relax smooth muscles and reduce ductal tone and spasm, thereby reducing pain.
Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis?
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Solution
Assessment for complications
The client with acute cholecystitis should first be monitored for perforation, fever, abscess, fistula, and sepsis. After assessment, antibiotics will be administered to reduce the infection. Lithotripsy is used only for a small percentage of clients. Surgery is usually done after the acute infection has subsided.