Ignatavicius: Medical-Surgical Nursing, 9th Edition
Care of Patients With Stomach Disorders
1. The nurse is performing medication reconciliation for a newly admitted client. The
nurse recognizes that which drugs contribute to signs and symptoms of gastritis? (Select
all that apply.)
a. Aspirin, taken once daily to prevent cardiac concerns
b. Naproxen, taken once daily for joint pain associated with arthritis
c. Amoxicillin, taken over a 10-day period for an acute sinus infection
d. Bacitracin ointment (over the counter), applied to minor scrapes on arms and legs
e. Prednisone, tapered over a 14-day period to decrease inflammation associated with an
acute sinus infection
ANS: A, B, E
Corticosteroids, erythromycin (E-Mycin, Erythromid), ASA (aspirin), and NSAIDs such
as naproxen (Naprosyn) and ibuprofen (Motrin, Advil, Amersol, Novo-Profen)—as well
as OTC products that contain aspirin or ibuprofen—are associated with contributing to
symptoms associated with gastritis. Amoxicillin and bacitracin ointment are not.
Cognitive Level: Analysis
Client Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
Nursing Process Step: Assessment/Evaluation
NCLEX Examination Challenge 55-2, Safe and Effective Care Environment
1. When caring for a patient who has just had an upper GI endoscopy, the nurse assesses
that the client has developed a temperature of 101.8F (38.8C). What is the appropriate
nursing intervention?
a. Promptly assess the patient for potential perforation.
b. Ask the nursing assistant to bathe the client with tepid water.
c. Administer acetaminophen (Tylenol) to lower the temperature.
d. Delegate to an unlicensed assistive personnel (UAP) to retake the temperature.
ANS: A
A sudden spike in temperature following an endoscopic procedure may indicate
perforation of the GI tract. The nurse should promptly conduct a further assessment of the
client, being aware of other signs and symptoms of perforation, such as a sudden onset of
acute upper abdominal pain; a rigid, board-like abdomen; and developing signs of shock.
Cognitive Level: Application
Client Needs Category: Physiological Integrity: Physiological Adaptation
Copyright © 2018 Elsevier Inc. All rights reserved.
Answer Key
55-2
Nursing Process Step: Implementation
NCLEX Examination Challenge 55-3, Physiological Integrity
1. The nurse is caring for a client with a bleeding duodenal ulcer who was admitted to the
hospital after vomiting bright, red blood. Which condition does the nurse anticipate when
the client develops a sudden, sharp pain in the midepigastric region and a rigid, boardlike abdomen?
a. Pancreatitis
b. Ulcer perforation
c. Small bowel obstruction
d. Development of additional ulcers
ANS: B
The body reacts to perforation of an ulcer by immobilizing the area as much as possible.
This results in board-like abdominal rigidity, usually with extreme pain. Perforation is a
medical emergency requiring immediate surgical intervention because peritonitis
develops quickly after perforation. A small bowel obstruction would not cause
midepigastric pain. The development of additional ulcers or pancreatitis would not cause
a rigid, board-like abdomen.
Cognitive Level: Application
Client Needs Category: Physiological Integrity: Physiological Adaptation
Nursing Process Step: Assessment/Evaluation
NCLEX Examination Challenge 55-4, Psychosocial Integrity
1. Which client statement regarding treatment for gastric cancer requires the nurse to
immediately intervene?
a. “I understand my treatment regimen.”
b. “My prognosis is frightening to me and my partner.”
c. “Life just does not seem to be worth living anymore.”
d. “There is a list of community resources stored in my computer for when I need them.”
ANS: C
This client statement requires immediate nursing intervention as it indicates that the client
may be experiencing hopelessness. The nurse should assess for suicidal thoughts, provide
therapeutic care and listening, and suggest referrals as needed.
Cognitive Level: Application
Client Needs Category: Psychosocial Integrity
Nursing Process Step: Assessment/Evaluation
Answer Key - Clinical Judgment Challenge
Copyright © 2018 Elsevier Inc. All rights reserved.
Answer Key
55-3
Clinical Judgment Challenge 55-1, Prioritization, Delegation, and Supervision
You are caring for a 55-year-old woman who was admitted after vomiting bright
red blood this morning. She states that she has a history of a stomach problem and
hypertension, and takes medication for both. She cannot provide the names of the
medications, yet does report that she had “a couple of alcoholic drinks” this
morning “to settle her nerves.” Vital signs show BP of 150/90, pulse of 108/minute,
respirations of 22/minute, and temperature of 98.6F. Assessment findings include
dry, pale skin, and a slightly distended abdomen with midepigastric moderate pain
(5 out of 10). She is alert and oriented. Her husband states that she reported feeling
lightheaded and tired over the past few days.
1. What additional assessment questions will you ask the patient and her husband?
ANS: Ask if the abdominal pain came on slowly or quickly. Ask if she has had any black
or bloody stools. Ask if she has a history of peptic ulcer disease (PUD), and if she knows
what specific “stomach problem” the medication she takes is for.
2. Which tasks can you appropriately delegate to the unlicensed assistive personnel
(UAP) working with you?
ANS: You can delegate the taking of vital signs to the UAP, with clear instructions that
results are to be immediately reported back to you. Intake and output can also be
delegated, again with clear instructions that information is to be immediately reported
back to you.
3. What assessment findings would you immediately report to the health care provider?
ANS: Changes in vital signs, intake and output (specifically if there is suspicion for fluid
overload), and laboratory findings should be immediately reported to the health care
provider. Contact the provider if further bloody emesis occurs, if there are changes in
mental status, and/or if there is an increase in abdominal pain.
4. What treatments do you anticipate that the health care provider will order if the patient
experiences perforation?
ANS: Perforation is managed by immediately replacing fluid, blood, and electrolytes,
administering antibiotics, and keeping the patient NPO.
Copyright © 2018 Elsevier Inc. All rights reserved.