The nurse is reviewing the medication record of a client with acute gastritis. Which medication if noted on the client's record, would the nurse question?

Correct Answer: B

Rationale: Indomethacin (Indocin) is a Nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, duodenum, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is an antidysrhythmic. Propranolol (Inderal) is a B- adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders.

Correct Answer: A

Rationale: A barium swallow is an x-ray study that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal tract. The client should fast for 8 to 12 hours before the test, depending on physician instructions. Most oral medications also are withheld before the test. After the procedure the nurse must monitor for constipation, which can occur as a result of the presence of barium in the gastrointestinal tract.

Correct Answer: C

Rationale: A liver disorder, such as cirrhosis, can disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Because of this, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

Correct Answer: B

Rationale: Oral cholecystography is a radiographic examination of the gallbladder that involves the ingestion of an oral contrast medium, typically containing iodine, to visualize the organ's structure and function. The primary nursing action before this test centers on patient safety, particularly in preventing adverse reactions to the contrast agent. Therefore, the nurse must first inquire about the client's history of allergies to iodine or shellfish, as these are common indicators of potential hypersensitivity to iodinated compounds. Shellfish allergy is particularly relevant because it often cross-reacts with iodine-based contrasts due to similar protein structures, potentially leading to anaphylaxis, urticaria, or other severe reactions. This assessment allows for premedication with steroids or antihistamines if needed, or for alternative imaging modalities like ultrasound to be considered. Failing to screen for these allergies could result in life-threatening complications, making this a critical pre-test step aligned with standard protocols from bodies like the American College of Radiology. In contrast, option A—having the client drink 1000 mL of water—is not a standard preparation for oral cholecystography. While hydration is generally encouraged for overall health, excessive water intake could dilute the oral contrast medium taken the night before the test, potentially reducing its effectiveness in concentrating within the gallbladder. Preparation typically involves a low-fat diet for several days prior to enhance gallbladder contraction and oral contrast administration (e.g., iopanoic acid tablets) the evening before, followed by fasting, but not forced large-volume water intake. Option C—administering an intravenous contrast agent the evening before—is incorrect because oral cholecystography specifically relies on oral, not intravenous, contrast to allow gradual absorption and gallbladder opacification over 12-14 hours. IV contrast is used in different procedures, such as intravenous pyelography or CT scans of the abdomen, where immediate vascular enhancement is needed. Introducing IV contrast here would be inappropriate, increase risks like nephrotoxicity without benefit, and deviate from the test's oral mechanism. Option D—administering tap-water enemas until clear—is a preparation method for lower gastrointestinal procedures, like barium enemas or colonoscopies, to clear bowel contents and reduce artifacts in the colon. However, oral cholecystography focuses on the upper abdomen and gallbladder, where bowel cleansing is unnecessary and could cause discomfort, electrolyte imbalances, or dehydration without improving image quality. Enemas might even interfere with contrast absorption if performed too close to the oral dose. By prioritizing allergy assessment, the nurse ensures a safe procedure, underscoring the importance of tailored pre-test planning based on the diagnostic method's requirements. This approach not only mitigates risks but also promotes patient education about potential symptoms to report, fostering trust and compliance.

Correct Answer: B

Rationale: During deamination of proteins, the liver splits the amino group from the carbon-containing compound, which results in the formation of ammonia and a carbon residue. The liver then converts the toxic ammonia substance into urea, which can be excreted by the kidneys. Clients with liver dysfunction may have high serum ammonia levels as a result.