Asbury's PowerPoint Questions from Chapters 41, 42, and 43... I think. Flashcards Preview

xxx Term 4: NUR 238 Medical-Surgical II > Asbury's PowerPoint Questions from Chapters 41, 42, and 43... I think. > Flashcards

Flashcards in Asbury's PowerPoint Questions from Chapters 41, 42, and 43... I think. Deck (9)
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1

THE NURSE IS CARING FOR A CLIENT FOLLOWING A BILLROTH II PROCEDURE. ON REVIEW OF THE POST-OPERATIVE ORDERS, WHICH OF THE FOLLOWING, IF PRESCRIBED, WOULD THE NURSE QUESTION AND VERIFY?

A. IRRIGATING THE NASOGASTRIC TUBE

B. COUGHING A DEEP BREATHING EXERCISES

C. LEG EXERCISES

D. EARLY AMBULATION

A. IRRIGATING THE NASOGASTRIC TUBE

In a Billroth II procedure the proximal remnant of the stomach is anastomased to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse should never irrigate or reposition the gastric tube after gastric surgery, unless specifically ordered by the physician. In this situation, the nurse would clarify the order.

Esophageal and Peptic Ulcers
Chapter 41 PowerPoint

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:

A. CUTTING THE VAGUS NERVE

B. REMOVING THE DISTAL PORTION OF THE STOMACH

C. REMOVAL OF THE ULCER AND A LARGE PORTION OF THE CELLS THAT PRODUCE HYDROCHLORIC ACID

D. AN INCISION AND RESUTURING OF THE PYLORUS TO RELAX THE MUSCLE AND ENLARGE THE OPENING FROM THE STOMACH TO THE DUODENUM

D. AN INCISION AND RESUTURING OF THE PYLORUS TO RELAX THE MUSCLE AND ENLARGE THE OPENING FROM THE STOMACH TO THE DUODENUM

Option D 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.

Esophageal and Peptic Ulcers
Chapter 41 PowerPoint

3

WHILE CARING FOR A CLIENT WITH PEPTIC ULCER DISEASE, THE CLIENT REPORTS THAT HE HAS BEEN NAUSEATED MOST OF THE DAY AND IS NOW FEELING LIGHTHEADED AND DIZZY. BASED UPON THESE FINDINGS, WHICH NURSING ACTIONS WOULD BE MOST APPROPRIATE FOR THE NURSE TO TAKE? SELECT ALL THAT APPLY.

A. ADMINISTERING AN ANTACID HOURLY UNTIL NAUSEA SUBSIDES.

B. MONITORING THE CLIENT’S VITAL SIGNS

C. NOTIFYING THE PHYSICIAN OF THE CLIENT’S SYMPTOMS

D. INITIATING OXYGEN THERAPY

E. REASSESSING THE CLIENT ON AN HOUR

C. NOTIFYING THE PHYSICIAN OF THE CLIENT’S SYMPTOMS

D. INITIATING OXYGEN THERAPY

The symptoms of nausea and dizziness in a client with peptic ulcer disease may be indicative of hemorrhage and should not be ignored. The appropriate nursing actions at this time are for the nurse to monitor the client’s vital signs and notify the physician of the client’s symptoms. To administer an antacid hourly or to wait one hour to reassess the client would be inappropriate; prompt intervention is essential in a client who is potentially experiencing a gastrointestinal hemorrhage. The nurse would notify the physician of assessment findings and then initiate oxygen therapy if ordered by the physician.

Esophageal and Peptic Ulcers
Chapter 41 PowerPoint

4

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:

A. CHECK THAT THE HEMOSTAT IS ON THE BEDSIDE

B. MONITOR IV FLUIDS FOR THE SHIFT

C. REGULARLY ASSESS RESPIRATORY STATUS

D. CHECK THAT THE BALLOON IS DEFLATED ON A REGULAR BASIS

C. 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

Esophageal and Peptic Ulcers
Chapter 41 PowerPoint

5

A patient with advanced cirrhosis who has ascites is short of breath and has an increased respiratory rate. The nurse should

a. Initiate oxygen therapy at 2 L/min to increase gas exchange.

b. Notify the health care provider so that a paracentesis can be performed.

c. Ask the patient to cough and breathe deeply to clear respiratory secretions.

d. Place the patient in Fowler’s position to relieve pressure on the diaphragm.

d. Place the patient in Fowler’s position to relieve pressure on the diaphragm.

Dyspnea is a frequent problem for the patient with ascites, and a semi-Fowler’s or Fowler’s position allows for maximal respiratory efficiency. Oxygen administration is not indicated; SpO2 level less than 90% would be an indication for oxygen. The respiratory distress is caused by ascites (not by respiratory secretions); coughing and deep breathing will not alleviate the respiratory distress. A paracentesis may be performed to remove ascitic fluid; however, this procedure provides only temporary relief and is reserved for severe respiratory distress or abdominal pain.

Cirrhosis of Liver
Chapter 43 PowerPoint

6

A 65 year old man with cirrhosis is brought in to the clinic by his wife after he had several days of staying up all night and sleeping all day, along with intermittent periods of "not making sense." He has asterixis on exam. What shoud be done for this patient?

a. Start a lactulose and titrate for 3 loose stools daily

b. Restrict the protein in his diet

c. Initiate metronidazole

d. Start furosemide

a. Start a lactulose and titrate for 3 loose stools daily

Cirrhosis of Liver
Chapter 43 PowerPoint

7

The surgical treatment of choice for the patient with symptomatic gallbladder disease is a

a.cholecystotomy.

b. choledocholithotomy.

c. cholecystoduodenostomy.

d. laparoscopic cholecystectomy.

d. laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is the surgical treatment of choice for patients with symptomatic cholelithiasis. The procedure is minimally invasive (puncture sites only), and the patient experiences minimal postoperative pain and is discharged on the day of surgery or on the day after. Most patients are able to resume normal activities and return to work within 1 week.

Liver, Biliary Tract
Chapter 43 PowerPoint

8

Postoperatively, a patient with an incisional cholecystectomy has a nursing diagnosis of ineffective breathing pattern related to splinted respirations secondary to a high abdominal incision. Which action should the nurse take first?

a. Assess heart and lung sounds.

b. Administer the prescribed analgesic.

c. Position the patient on the operative side.

d. Instruct the patient to cough and deep breathe.

b. Administer the prescribed analgesic.

Postoperative nursing care for incisional cholecystectomy focuses on adequate ventilation and prevention of respiratory complications. The patient will need adequate pain control for optimum coughing and deep breathing to prevent postoperative atelectasis.

Liver, Biliary Tract
Chapter 43 PowerPoint

9

THE NURSE EXPLAINS TO A PATIENT WITH AN EPISODE OF ACUTE PANCREATITIS THAT THE MOST EFFECTIVE MEANS OF RELIEVING PAIN BY SUPPRESSING PANCREATIC SECRETIONS IS THE USE OF

a. ANTIBIOTICS.

b. NPO STATUS.

c. ANTISPASMODICS.

d. PROTON PUMP INHIBITORS.

b. NPO STATUS.

Pain from acute pancreatitis is aggravated by eating; NPO status will help to alleviate the pain by decreasing pancreatic secretions.

Biliary Tract, Pranceatitis
Chapter 43 PowerPoint