Answer Key to Chapter 7 Clinical Reasoning and Decision-Making Activities

You can review additional information regarding these answers in the corresponding section in which the clinical reasoning and decision-making activities appear.

Activity Section 7.5

Postoperative clients often require a proton pump inhibitor due to the stress response that occurs during surgery and hospitalization. Pantoprazole suppresses the secretion of hydrochloric acid and prevents the formation of a stress ulcer.

Activity Section 7.6a

1. The client may be experiencing increased heart rate as a symptom of dehydration associated with water loss from diarrhea. Additionally, a Black Box Warning for loperamide is abnormal heart rhythm. The nurse should assess the client’s heart rate and rhythm and notify the provider.

2. The nurse can recommend providing over-the-counter probiotics, which are also found in yogurt, for the prevention of diarrhea associated with antibiotic use or to assist in decreasing the symptoms of diarrhea.

Activity Section 7.6b

1. A postoperative client has many risk factors for constipation, including side effects of anesthesia and opiates, sedentary levels of activity, and decreased fluid and food intake after surgery.   In addition to administering docusate or other laxatives as needed, the nurse should educate the client about nonpharmacological interventions to relieve constipation, such as increased fluid and fiber intake and walking.

2. Docusate softens the stool and improves the regularity of bowel movements.

3. Docusate usually works within 12-72 hours.  If it is not effective in creating a bowel movement with soft stool, the client should be instructed to notify the nurse and additional laxatives can be administered.

4. Preventative measures for constipation include increasing fluid and fiber intake, ambulating, and using the least amount of opiates needed to effectively treat the pain.

5. Bowel protocols usually include a step-wise approach to constipation.  Docusate or polyethylene glycol 3350 are often used preventively, but if a bowel movement does not occur within the expected timeframe, additional laxatives such as bisacodyl or an enema may be added.  A bisacodyl suppository generally produces a bowel movement within one hour whereas a mineral oil enema usually works within 15 minutes of administration.

Activity Section 7.7

1. The nurse assesses for dehydration by monitoring blood pressure for hypotension, heart rate for tachycardia, urine output for decreased level, skin for tenting, and mucus membranes for dryness.

2. The dissolving tablets eliminate the risk of vomiting the medication before it is absorbed. If the client can’t tolerate the dissolving tablets, the nurse can request the provider to change the route of ondansetron to the intravenous route.

3. The nurse should plan to proactively administer medications before meals to prevent nausea. The client can also be instructed to follow a bland diet to prevent feelings of nausea that can be stimulated by spicy food or strong flavors.  Fluids should be encouraged to prevent dehydration, but if fluids increase the client’s feelings of nausea, the client can be instructed to take frequent sips of fluid or suck on ice chips.