A. Decreased blood pressure
B. Absence of muscle tremors
C. Relief of nausea and vomiting
D. No further episodes of diarrhea
Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient’s nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.
A. Morphine sulfate
B. Zolpidem (Ambien)
C. Ondansetron (Zofran)
D. Dexamethasone (Decadron)
D. Lower abdominal pain
Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.
C. Double vision
D. Numbness in fingers and toes
Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.
C. Reduced hearing
D. Sensation of falling
Although being given to this patient as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the patient is likely to experience drowsiness as an adverse effect of the medication. Tinnitus, reduced hearing, and loss of balance are not side effects of promethazine.
C. Epigastric pain
D. Difficulty swallowing
Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain. Famotidine is not indicated for nausea, belching, and dysphagia.
A. Digoxin (Lanoxin)
B. Cefotetan (Cefotan)
C. Famotidine (Pepcid)
D. Promethazine (Phenergan)
A common adverse effect of promethazine, an antihistamine/antiemetic agent, is dry mouth; another is blurred vision. Common side effects of digoxin are yellow halos and bradycardia. Common side effects of cefotetan are nausea, vomiting, stomach pain, and diarrhea. Common side effects of famotidine are headache, abdominal pain, constipation, or diarrhea.
A. Providing IV fluids and inserting a nasogastric (NG) tube
B. Administering oral bicarbonate and testing the patient’s gastric pH level
C. Performing a fecal occult blood test and administering IV calcium gluconate
D. Starting parenteral nutrition and placing the patient in a high-Fowler’s position
A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium gluconate is not a medication directly relevant to the patient’s suspected diagnosis, and parenteral nutrition is not a priority in the short term.
A. Keep the patient NPO.
B. Put the bed in the Trendelenberg position.
C. Have the patient eat 4 to 6 smaller meals each day.
D. Give various antacids to determine which one works for the patient.
Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the care provider’s prescription, so this is not a nursing intervention.
A. Chest pain relieved with eating or drinking water
B. Back pain 3 or 4 hours after eating a meal
C. Burning epigastric pain 90 minutes after breakfast
D. Rigid abdomen and vomiting following indigestion
A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.
A. Antibiotic(s), antacid, and corticosteroid
B. Antibiotic(s), aspirin, and antiulcer/protectant
C. Antibiotic(s), proton pump inhibitor, and bismuth
D. Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs)
To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.
A. Abdominal pain and bloating
B. No bowel movement for 3 days
C. A decrease in appetite by 50% over 24 hours
D. Muscle tremors and other signs of hypomagnesemia
MOM is an osmotic laxative that produces a soft, semisolid stool usually within 15 minutes to 3 hours. This medication would benefit the patient who has not had a bowel movement for 3 days. MOM would not be given for abdominal pain and bloating, decreased appetite, or signs of hypomagnesemia.
A. Increases bulk in the stool
B. Lubricates the intestinal tract to soften feces
C. Increases fluid retention in the intestinal tract
D. Increases peristalsis by stimulating nerves in the colon wall
Bisacodyl is a stimulant laxative that aids in producing a bowel movement by irritating the colon wall and stimulating enteric nerves. It is available in oral and suppository forms. Fiber and bulk forming drugs increase bulk in the stool; water and stool softeners soften feces, and saline and osmotic solutions cause fluid retention in the intestinal tract.
A. Take a dose of mineral oil at the same time.
B. Add extra salt to food on at least one meal tray.
C. Ensure dietary intake of 10 g of fiber each day.
D. Take each dose with a full glass of water or other liquid.
Docusate lowers the surface tension of stool, permitting water and fats to penetrate and soften the stool for easier passage. The patient should take the dose with a full glass of water and should increase overall fluid intake, if able, to enhance effectiveness of the medication. Dietary fiber intake should be a minimum of 20 g daily to prevent constipation. Mineral oil and extra salt are not recommended.
A. Bisacodyl (Dulcolax)
B. Lubiprostone (Amitiza)
C. Cascara sagrada (Senekot)
D. Magnesium hydroxide (Milk of Magnesia)
Milk of Magnesia may cause hypermagnesemia in patients with renal insufficiency. The nurse should question this order with the health care provider. Bisacodyl, lubiprostone, and cascara sagrada are safe to use in patients with renal insufficiency as long as the patient is not currently dehydrated.
A. Low-pitched and rumbling above the area of obstruction
B. High-pitched and hypoactive below the area of obstruction
C. Low-pitched and hyperactive below the area of obstruction
D. High-pitched and hyperactive above the area of obstruction
Early in intestinal obstruction, the patient’s bowel sounds are hyperactive and high-pitched, sometimes referred to as “tinkling” above the level of the obstruction. This occurs because peristaltic action increases to “push past” the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.
B. History of colorectal polyps
C. History of lactose intolerance
D. Use of herbs as dietary supplements
A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.
A. 7:00 AM, 10:00 AM, and 1:00 PM
B. 8:00 AM, 12:00 PM, and 4:00 PM
C. 9:00 AM and 3:00 PM
D. 9:00 AM, 12:00 PM, and 3:00 PM
A nasogastric tube should be checked for patency routinely at 4-hour intervals. Thus if the tube were inserted at 4:00 AM, it would be due to be checked at 8:00 AM, 12:00 PM, and 4:00 PM.
A. How to care for the wound
B. How to deep breathe and cough
C. The location and care of drains after surgery
D. Which medications will be used during surgery
Because anesthesia, an abdominal incision, and pain can impair the patient’s respiratory status in the postoperative period, it is of high priority to teach the patient to cough and deep breathe. Otherwise, the patient could develop atelectasis and pneumonia, which would delay early recovery from surgery and hospital discharge. Care for the wound and location and care of the drains will be briefly discussed preoperatively, but done again with higher priority after surgery. Knowing which drugs will be used during surgery may not be meaningful to the patient and should be reviewed with the patient by the anesthesiologist.
A. impaired peristalsis.
B. irritation of the bowel.
C. nasogastric suctioning.
D. inflammation of the incision site.
Until peristalsis returns to normal following anesthesia, the patient may experience slowed gastrointestinal motility leading to gas pains and abdominal distention. Irritation of the bowel, nasogastric suctioning, and inflammation of the surgical site do not cause gas pains or abdominal distention.
A. Notify the physician.
B. Auscultate for bowel sounds.
C. Reposition the tube and check for placement.
D. Remove the tube and replace it with a new one.
The tube may be resting against the stomach wall. The first action by the nurse (since this is intestinal surgery and not gastric surgery) is to reposition the tube and check it again for placement. The physician does not need to be notified unless the tube function cannot be restored by the nurse. The patient does not have bowel sounds, which is why the NG tube is in place. The NG tube would not be removed and replaced unless it was no longer in the stomach or the obstruction of the tube could not be relieved.
A. “This will prevent air from accumulating in the stomach, causing gas pains.”
B. “This will prevent the heartburn that occurs as a side effect of general anesthesia.”
C. “The stress of surgery is likely to cause stomach bleeding if you do not receive it.”
D. “This will reduce the amount of HCl in the stomach until the nasogastric tube is removed and you can eat a regular diet again.”
Famotidine is an H2-receptor antagonist that inhibits gastric HCl secretion and thus minimizes damage to gastric mucosa while the patient is not eating a regular diet after surgery. Famotidine does not prevent air from accumulating in the stomach or stop the stomach from bleeding. Heartburn is not a side effect of general anesthesia.
A. Fecal impaction
B. Perineal hygiene
C. Dietary fiber intake
D. Antidiarrheal agent use
Patients with limited mobility are at risk for fecal impactions due to constipation that may lead to liquid stool leaking around the hardened impacted feces, so assessing for fecal impaction is the priority. Perineal hygiene can be assessed at the same time. Assessing the dietary fiber and fluid intake and antidiarrheal agent use will be assessed and considered next.
A. Restricted to rectum
B. Strictures are common.
C. Bloody, diarrhea stools
D. Cramping abdominal pain
E. Lesions penetrate intestine.
Clinical manifestations of UC and Crohn’s disease include bloody diarrhea, cramping abdominal pain, and nutritional disorders. Intestinal lesions associated with UC are usually restricted to the rectum before moving into the colon. Lesions that penetrate the intestine or cause strictures are characteristic of Crohn’s disease.
A. “I can have a glass of low-fat milk at bedtime.”
B. “I will have to eliminate all spicy foods from my diet.”
C. “I will have to use herbal teas instead of caffeinated drinks.”
D. “I should keep something in my stomach all the time to neutralize the excess acids.”
Rationale: Patients with gastroesophageal reflux disease should avoid foods (such as tea and coffee) that decrease lower esophageal pressure. Patients should also avoid milk, especially at bedtime, as it increases gastric acid secretion. Patients may eat spicy foods, unless these foods cause reflux. Small, frequent meals help prevent overdistention of the stomach, but patients should avoid late evening meals and nocturnal snacking.