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55 - Chapter 55 Care of Patients with Stomach Disorders...

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Chapter 55: Care of Patients with Stomach Disorders Ignatavicius: Medical-Surgical Nursing, 8th Edition MULTIPLE CHOICE 1. The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the client’s abdomen is tense and rigid. What action takes priority? a. Administer the prescribed pain medication. b. Notify the health care provider immediately. c. Percuss all four abdominal quadrants. d. Take and document a set of vital signs. ANS: B This client has manifestations of a perforated ulcer, which is an emergency. The priority is to get the client medical attention. The nurse can take a set of vital signs while someone else calls the provider. The nurse should not percuss the abdomen or give pain medication since the client may need to sign consent for surgery. DIF: Applying/Application REF: 1132 KEY: Gastrointestinal disorders| nursing assessment| communication MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 2. A client has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority? DIF: Analyzing/Analysis REF: 1132 KEY: Gastrointestinal disorders| electrolyte imbalances| cardiac system MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 3. A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client’s blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate?
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DIF: Applying/Application REF: 1136 KEY: Gastrointestinal disorders| fluid imbalances| nursing assessment MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
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