1.
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?
Correct Answer
A. “The cimetidine (Tagamet) will cause me to produce less stomach acid.”
Explanation
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.
2.
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:
Correct Answer
D. An incision and resuturing of the pylorus to relax the muscle and enlarge the opening from the stomach to the duodenum.
Explanation
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.
3.
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:
Correct Answer
D. Reduces the stimulus to acid secretions
Explanation
A vagotomy. or cutting the vagus nerve. is done to eliminate parasympathetic stimulation of gastric secretion.
4.
The nurse would assess the client experiencing an acute episode of cholecystitis for pain that is located in the right
Correct Answer
B. Upper quadrant and radiates to the right scapula and shoulder
Explanation
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.
5.
Which of the following tasks should be included in the immediate postoperative management of a client who has undergone gastric resection?
Correct Answer
D. Monitoring for symptoms of hemorrhage
Explanation
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.
6.
If a gastric acid perforates. which of the following actions should not be included in the immediate management of the client?
Correct Answer
B. Antacid administration
Explanation
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.
7.
Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications?
Correct Answer
C. To stimulate mucus production
Explanation
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.
8.
When counseling a client in ways to prevent cholecystitis. which of the following guidelines is most important?
Correct Answer
D. Keep weight proportionate to height
Explanation
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.
9.
Which of the following symptoms best describes Murphy’s sign?
Correct Answer
C. On deep inspiration. pain is elicited and breathing stops
Explanation
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.
10.
Which of the following tests is most commonly used to diagnose cholecystitis?
Correct Answer
B. Abdominal ultrasound
Explanation
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.