Unintentional weight loss is not a normal finding and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older patients. These will need to be addressed but are not of as
Unintended weight loss
Difficulty chewing food
Complaints of indigestion
The gastrocolic reflex is most active after the first daily meal. Arising in the morning, the anticipation of eating, and physical exercise do not stimulate these reflexes.
right after getting up in the morning.
in the mid-afternoon.
immediately before the first daily meal.
after eating breakfast.
The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, eleva
cobalamin (vitamin B12) deficiency.
elevated total serum cholesterol.
A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal (GI) bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction
decreased serum cholesterol levels.
increased serum indirect bilirubin levels.
If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication t
The patient refused to drink the ordered polyethylene glycol (GoLYTELY).
The patient has a permanent pacemaker to prevent bradycardia.
The patient has had an allergic reaction to shellfish and iodine in the past.
The patient is worried about discomfort during the examination.
Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient’s jaundice. The other patient statements require further assessment by the nurse, but do not indicate a need for patient education.
“I used cough syrup several times a day last week.”
“I need to take an antacid for indigestion several times a week”
“I take a baby aspirin every day to prevent strokes.”
“I use acetaminophen (Tylenol) every 4 hours for back pain.”
The liver is normally not palpable below the costal margin. The nurse needs to push inward below the right costal margin while lifting the patient’s back slightly with the left hand. The other methods will not allow palpation of the liver.
presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt.
places one hand under the patient’s lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.
places one hand on the patient’s back and presses upward and inward with the other hand below the patient’s right costal margin.
places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge.
Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may be heard normally.
Absent bowel sounds
Frequent clicking sounds
After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site.
check the patient’s postbiopsy coagulation studies.
put pressure on the biopsy site using a sandbag.
elevate the head of the bed to facilitate breathing.
place the patient on the right side with the bed flat.
Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the s
The patient ate a low-fat bagel 4 hours ago for breakfast.
The patient has a permanent gastrostomy tube in place.
The patient had a high-fat meal the previous evening.
The patient took a laxative the previous evening.
This question is the most open-ended, and will provide the best overall information about the patient’s daily intake and risk for poor nutrition. The other questions may be asked, depending on the patient’s response to the first question.
“Can you tell me the food that you ate yesterday?”
“How do you get to the store to buy your food?”
“Are you taking any medications that alter your taste for food?”
“Do you have any difficulty in preparing or eating food?”
A temperature elevation may indicate that a perforation has occurred. The other assessment data are normal immediately after the procedure.
The oral temperature is 101.6° F.
The patient is very drowsy.
The apical pulse is 104 beats/minute.
The patient reports a sore throat.
Normally the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly. The other findings are within normal range for the physical assessment.
Bowel sounds of 20/minute in each quadrant
Liver edge 3 cm below the costal margin
Aortic pulsations visible in the epigastric area
Tympany on percussion of the abdomen
Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN. The other actions by the UAP are appropriate.
Swabbing the patient’s mouth with cold water
Checking the vital signs every 30 minutes
Positioning the patient on the right side
Offering the patient a drink of water
The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse’s initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO.
Teach the patient about the procedure.
Place the patient on NPO status.
Ensure the consent form is signed.
Administer sedative medications.
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