1. The nurse is caring for a client who is at risk for developing gastritis. Which finding from the client’s history leads the nurse to this conclusion?

a.            Client is lactose intolerant and cannot drink milk.

b.            Client recently traveled to Mexico and South America.

c.             Client works at least 60 hours per week in a stressful job.

d.            Client takes naproxen sodium (Naprosyn) 500 mg daily for arthritis pain.

ANS: D

Motrin and other NSAIDs can cause gastritis, even if symptoms are not yet apparent. Stress, travel, and spicy foods do not increase the risk for gastritis.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Analysis)

2. The nurse is caring for a female client who has just received a prescription for misoprostol (Cytotec). Which instructions does the nurse provide to the client regarding this medication?

a.            “You may dissolve the contents of the capsule in warm water if it is difficult for you to swallow.”

b.            “Take this medication on an empty stomach just before going to bed every evening.”

c.             “You will need to stop taking your magnesium hydroxide (Mylanta) now that you are on this drug.”

d.            “You should add extra fiber to your diet because this medication may cause constipation.”

ANS: C

Misoprostol is a prostaglandin analogue. Clients on this medication need to avoid magnesium-containing antacids; Mylanta contains magnesium. Clients should not dissolve the pill, should take misoprostol with food, and do not need to take precautions against constipation while on this drug.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Teaching/Learning

3. The nurse is caring for a client with a gastric ulcer who suddenly develops sharp mid-epigastric pain. The nurse notes that the client’s abdomen is hard and very tender to light palpation. Which is the priority action of the nurse?

a.            Place the client in a knee-chest position.

b.            Prepare the client for emergency surgery.

c.             Insert a nasogastric (NG) tube to low intermittent suction.

d.            Assess the client’s pain and administer analgesics.

ANS: B

Sudden, sharp mid-epigastric pain is indicative of perforation, which is a surgical emergency. Pain medication should not be administered just now because the surgeon will need to assess the client’s abdomen, and the client will need to sign an operative permit. The client may assume the knee-chest position in an attempt to relieve pain. The provider may order placement of an NG tube, but this would not take priority over getting the client ready for surgery.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Medical Emergencies) MSC: Integrated Process: Nursing Process (Implementation)

4. The nurse is caring for a client with peptic ulcer disease. The client vomits a large amount of undigested food after breakfast. Which intervention does the nurse prepare to provide for the client?

a.            Administer a soap suds cleansing enema.

b.            Change the client’s diet to clear liquids only.

c.             Insert a nasogastric (NG) tube to low intermittent suction.

d.            Administer prochlorperazine (Compazine) 10 mg IM.

ANS: C

Symptoms of abdominal distention and nausea and vomiting of undigested food signal pyloric obstruction. Treatment is aimed at decompression of the stomach by an NG tube and restoration of fluid and electrolyte balance. The client should remain NPO, and a soap suds cleansing enema is not indicated. Decompressing the stomach should alleviate the nausea, but if antiemetics are ordered, they would not take priority over decompressing the stomach.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

5. The home care nurse is caring for a client who has recently undergone a subtotal gastrectomy. The nurse notes that the client’s tongue is shiny and beefy red. Which assessment question does the nurse ask the client regarding this finding?

a.            “Have you been taking your multivitamin every day?”

b.            “How much weight have you lost since your surgery?”

c.             “Have you been experiencing heartburn or nausea after eating?”

d.            “What kind of mouthwash do you use after you brush your teeth?”

ANS: A

Symptoms of atrophic glossitis are caused by a decrease in vitamin B12, which results from lack of intrinsic factor secondary to surgical resection of a portion of the stomach. The nurse should check to see whether the client has been taking the prescribed multivitamin every day. The other questions will not help the nurse discover the cause of this finding.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

6. The nurse is providing discharge teaching for a client who has peptic ulcer disease caused by Helicobacter pylori infection. Which statement by the client indicates that additional teaching is needed?

a.            “I will avoid drinking coffee, even if it is decaffeinated.”

b.            “I will take a multivitamin every morning with breakfast.”

c.             “I will go to my tai chi class to wind down after a busy day.”

d.            “I will take my medication every day until my heartburn is gone.”

ANS: D

Long-term medication compliance is crucial to eradicate Helicobacter pylori and prevent recurrence. The nurse stresses the importance of continuing medications for the entire time prescribed. Decaffeinated coffee is a better choice than caffeinated coffee for the client with peptic ulcer disease. Stress management should also be part of the treatment plan. Good nutrition is always important.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)