GASTROINTESTINAL DISORDERS CHAPTER 7 QUESTIONS & ANSWERS WITH RATIONALS (GUARANTEED A+)

GASTROINTESTINAL DISORDERS CHAPTER 7 QUESTIONS & ANSWERS WITH RATIONALS (GUARANTEED A+) chapter 7 gaStrointeStinal diSorderS 249 Gastrointestinal Disorders 7 Science is knowledge; wisdom is organized life. —Immanuel Kant The many organs making up the gastrointestinal system—the mouth, esophagus, stomach, upper and lower intestine, and related organs—are subject to many disorders/diseases. Some are relatively minor, such as temporary constipation or a short bout of diarrhea and gastroenteritis. Others, such as diverticulosis and inflammatory bowel disease, may be chronic, requiring the client to follow a specific diet and other lifestyle modifications. Some chronic diseases, including gastroesophageal reflux, may eventually lead to life-threatening problems such as esophageal cancer. Still other diseases affect the gastrointestinal tract. One—colon cancer—is one of the most common cancers in the United States. In addition, eating disorders rooted in psychological problems can be serious if not addressed promptly and effectively. Because gastrointestinal diseases/disorders are so common, the nurse must be aware of the signs/symptoms of each, what is considered normal or abnormal for the disease process, and how the specific problem is treated. 250 Med-Surg SucceSS KEYWORDS Ascites Asterixis Borborygmus Caput medusae Cathartic Cruciferous Dyspepsia Dysphagia Eructation Esophagogastroduodenoscopy Evisceration Exacerbation Feces Hematemesis Hypoalbuminemia Jaundice Lower esophageal sphincter Melena Nosocomial Odynophagia Oligomenorrhea Peritonitis Pruritus Pyrosis abbREviatiOnS Acquired immunodeficiency syndrome (AIDS) Blood pressure (BP) Body mass index (BMI) Esophagogastroduodenoscopy (EGD) Gastroesophageal reflux disease (GERD) Gastrointestinal (GI) Head of bed (HOB) Health-care provider (HCP) Inflammatory bowel disease (IBD) Intake and output (I&O) International normalized ratio (INR) Intravenous (IV) Nasogastric (N/G) tube Nonsteroidal anti-inflammatory drugs (NSAIDs) Nothing by mouth (NPO) Partial thromboplastin time (PTT) Patient-controlled analgesia (PCA) Percutaneous endoscopic gastrostomy (PEG) Prothrombin time (PT) Pulse (P) Red blood cells (RBCs) Three times a day (tid) Total parenteral nutrition (TPN) 249 Sedentary Steatorrhea Tenesmus Water brash Unlicensed assistive personnel (UAP) When required, as needed (prn) White blood cells (WBCs) Within normal limits (WNL) PRaCtiCE QUEStiOnS Gastroesophageal Reflux (GERD) 1. The male client tells the nurse he has been experiencing “heartburn” at night that awakens him. Which assessment question should the nurse ask? 1. “How much weight have you gained recently?” 2. “What have you done to alleviate the heartburn?” 3. “Do you consume many milk and dairy products?” 4. “Have you been around anyone with a stomach virus?” 2. The nurse caring for a client diagnosed with GERD writes the client problem of “behavior modification.” Which intervention should be included for this problem? 1. Teach the client to sleep with a foam wedge under the head. 2. Encourage the client to decrease the amount of smoking. 3. Instruct the client to take over-the-counter medication for relief of pain. 4. Discuss the need to attend Alcoholics Anonymous to quit drinking. 3. The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy (EGD). Which statement indicates the client understands the discharge instructions? 1. “I should not eat for at least one (1) day following this procedure.” 2. “I can lie down whenever I want after a meal. It won’t make a difference.” 3. “The stomach contents won’t bother my esophagus but will make me nauseous.” 4. “I should avoid orange juice and eating tomatoes until my esophagus heals.” 4. The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? 1. Allow any of the client’s favorite foods as long as the amount is limited. chapter 7 gaStrointeStinal diSorderS 251 2. Have the client perform eructation exercises several times a day. 3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. 4. Encourage the client to consume a glass of red wine with one (1) meal a day. 5. The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented? 1. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications. 2. Have the client remain upright at all times and walk for 30 minutes three (3) times a week. 3. Instruct the client to maintain a right lateral sidelying position and take antacids before meals. 4. Elevate the head of the bed (HOB) 30 degrees and discuss lifestyle modifications with the client. 6. The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD? 1. Adult-onset asthma. 2. Pancreatitis. 3. Peptic ulcer disease. 4. Increased gastric emptying. 7. The nurse is administering morning medications at 0730. Which medication should have priority? 1. A proton pump inhibitor. 2. A nonnarcotic analgesic. 3. A histamine receptor antagonist. 4. A mucosal barrier agent. 8. The nurse is preparing a client diagnosed with GERD for surgery. Which information warrants notifying the HCP? 1. The client’s Bernstein esophageal test was positive. 2. The client’s abdominal x-ray shows a hiatal hernia. 3. The client’s WBC count is 14,000/mm3 . 4. The client’s hemoglobin is 13.8 g/dL. 9. The charge nurse is making assignments. Staffing includes a registered nurse with five (5) years of medical-surgical experience, a newly graduated registered nurse, and two (2) unlicensed assistive personnel (UAPs). Which client should be assigned to the most experienced nurse? 1. The 39-year-old client diagnosed with lower esophageal dysfunction who is complaining of pyrosis. 2. The 54-year-old client diagnosed with Barrett’s esophagus who is scheduled to have an endoscopy this morning. 3. The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all five (5) lobes. 4. The 68-year-old client who is three (3) days postoperative for hiatal hernia and needs to be ambulated four (4) times today. 10. Which statement made by the client indicates to the nurse the client may be experiencing GERD? 1. “My chest hurts when I walk up the stairs in my home.” 2. “I take antacid tablets with me wherever I go.” 3. “My spouse tells me I snore very loudly at night.” 4. “I drink six (6) to seven (7) soft drinks every day.” 11. The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence. 2. Weight loss, dysarthria, and diarrhea. 3. Decreased abdominal fat, proteinuria, and constipation. 4. Midepigastric pain, positive H. pylori test, and melena. 12. Which disease is the client diagnosed with GERD at greater risk for developing? 1. Hiatal hernia. 2. Gastroenteritis. 3. Esophageal cancer. 4. Gastric cancer. inflammatory bowel Disease 13. Which sign/symptom should the nurse expect to find in a client diagnosed with ulcerative colitis? 1. Twenty bloody stools a day. 2. Oral temperature of 102°F. 3. Hard, rigid abdomen. 4. Urinary stress incontinence. 14. The client with type 2 diabetes is prescribed prednisone, a steroid, for an acute exacerbation of inflammatory bowel disease (IBD). Which intervention should the nurse discuss with the client? 1. Take this medication on an empty stomach. 2. Notify the HCP if experiencing a moon face. 3. Take the steroid medication as prescribed. 4. Notify the HCP if the blood glucose is over 160. 252 Med-Surg SucceSS 15. The client diagnosed with inflammatory bowel disease has a serum potassium level of 3.4 mEq/L. Which action should the nurse implement first? 1. Notify the health-care provider (HCP). 2. Assess the client for muscle weakness. 3. Request telemetry for the client. 4. Prepare to administer potassium IV. 16. The client is diagnosed with an acute exacerbation of ulcerative colitis. Which intervention should the nurse implement? 1. Provide a low-residue diet. 2. Rest the client’s bowel. 3. Assess vital signs daily. 4. Administer antacids orally. 17. The client diagnosed with IBD is prescribed total parenteral nutrition (TPN). Which intervention should the nurse implement? 1. Check the client’s glucose level. 2. Administer an oral hypoglycemic. 3. Assess the peripheral intravenous site. 4. Monitor the client’s oral food intake. 18. The client is diagnosed with an acute exacerbation of IBD. Which priority intervention should the nurse implement? 1. Weigh the client daily and document in the client’s chart. 2. Teach coping strategies such as dietary modifications. 3. Record the frequency, amount, and color of stools. 4. Monitor the client’s oral fluid intake every shift. 19. The client diagnosed with Crohn’s disease is crying and tells the nurse, “I can’t take it anymore. I never know when I will get sick and end up here in the hospital.” Which statement is the nurse’s best response? 1. “I understand how frustrating this must be for you.” 2. “You must keep thinking about the good things in your life.” 3. “I can see you are very upset. I’ll sit down and we can talk.” 4. “Are you thinking about doing anything like committing suicide?” 20. The client diagnosed with ulcerative colitis has an ileostomy. Which statement indicates the client needs more teaching concerning the ileostomy? 1. “My stoma should be pink and moist.” 2. “I will irrigate my ileostomy every morning.” 3. “If I get a red, bumpy, itchy rash I will call my HCP.” 4. “I will change my pouch if it starts leaking.” 21. The client diagnosed with IBD is prescribed sulfasalazine (Asulfidine), a sulfonamide antibiotic. Which statement best describes the rationale for administering this medication? 1. It is administered rectally to help decrease colon inflammation. 2. This medication slows gastrointestinal (GI) motility and reduces diarrhea. 3. This medication kills the bacteria causing the exacerbation. 4. It acts topically on the colon mucosa to decrease inflammation. 22. The client is diagnosed with Crohn’s disease, also known as regional enteritis. Which statement by the client supports this diagnosis? 1. “My pain goes away when I have a bowel movement.” 2. “I have bright red blood in my stool all the time.” 3. “I have episodes of diarrhea and constipation.” 4. “My abdomen is hard and rigid and I have a fever.” 23. The client diagnosed with ulcerative colitis is prescribed a low-residue diet. Which meal selection indicates the client understands the diet teaching? 1. Grilled hamburger on a wheat bun and fried potatoes. 2. A chicken salad sandwich and lettuce and tomato salad. 3. Roast pork, white rice, and plain custard. 4. Fried fish, whole grain pasta, and fruit salad. 24. The client with ulcerative colitis is scheduled for an ileostomy. The nurse is aware the client’s stoma will be located in which area of the abdomen? 1. A 2. B 3. C 4. D Peptic Ulcer Disease 25. Which assessment data supports the client’s diagnosis of gastric ulcer to the nurse? 1. Presence of blood in the client’s stool for the past month. 2. Reports of a burning sensation moving like a wave. C B D A chapter 7 gaStrointeStinal diSorderS 253 3. Sharp pain in the upper abdomen after eating a heavy meal. 4. Complaints of epigastric pain 30 to 60 minutes after ingesting food. 26. The nurse is caring for a client diagnosed with ruleout peptic ulcer disease. Which test confirms this diagnosis? 1. Esophagogastroduodenoscopy. 2. Magnetic resonance imaging (MRI). 3. Occult blood test. 4. Gastric acid stimulation. 27. Which specific data should the nurse obtain from the client who is suspected of having peptic ulcer disease? 1. History of side effects experienced from all medications. 2. Use of nonsteroidal anti-inflammatory drugs ( NSAIDs ). 3. Any known allergies to drugs and environmental factors. 4. Medical histories of at least three (3) generations. 28. Which physical examination should the nurse implement first when assessing the client diagnosed with peptic ulcer disease? 1. Auscultate the client’s bowel sounds in all four quadrants. 2. Palpate the abdominal area for tenderness. 3. Percuss the abdominal borders to identify organs. 4. Assess the tender area progressing to nontender. 29. Which problems should the nurse include in the plan of care for the client diagnosed with peptic ulcer disease to observe for physiological complications? 1. Alteration in bowel elimination patterns. 2. Knowledge deficit in the causes of ulcers. 3. Inability to cope with changing family roles. 4. Potential for alteration in gastric emptying. 30. The nurse is caring for a client diagnosed with hemorrhaging duodenal ulcer. Which collaborative interventions should the nurse implement? Select all that apply. 1. Perform a complete pain assessment. 2. Assess the client’s vital signs frequently. 3. Administer a proton pump inhibitor intravenously. 4. Obtain permission and administer blood products. 5. Monitor the intake of a soft, bland diet. 31. Which expected outcome should the nurse include for a client diagnosed with peptic ulcer disease? 1. The client’s pain is controlled with the use of NSAIDs. 2. The client maintains lifestyle modifications. 3. The client has no signs and symptoms of hemoptysis. 4. The client takes antacids with each meal. 32. The nurse has been assigned to care for a client diagnosed with peptic ulcer disease. Which assessment data require further intervention? 1. Bowel sounds auscultated 15 times in one (1) minute. 2. Belching after eating a heavy and fatty meal late at night. 3. A decrease in systolic blood pressure (BP) of 20 mm Hg from lying to sitting. 4. A decreased frequency of distress located in the epigastric region. 33. Which oral medication should the nurse question before administering to the client with peptic ulcer disease? 1. E-mycin, an antibiotic. 2. Prilosec, a proton pump inhibitor. 3. Flagyl, an antimicrobial agent. 4. Tylenol, a nonnarcotic analgesic. 34. The nurse has administered an antibiotic, a proton pump inhibitor, and Pepto-Bismol for peptic ulcer disease secondary to H. pylori. Which data would indicate to the nurse the medications are effective? 1. A decrease in alcohol intake. 2. Maintaining a bland diet. 3. A return to previous activities. 4. A decrease in gastric distress. 35. Which assessment data indicate to the nurse the client’s gastric ulcer has perforated? 1. Complaints of sudden, sharp, substernal pain. 2. Rigid, boardlike abdomen with rebound tenderness. 3. Frequent, clay-colored, liquid stool. 4. Complaints of vague abdominal pain in the right upper quadrant. 36. The client with a history of peptic ulcer disease is admitted into the intensive care department with frank gastric bleeding. Which priority intervention should the nurse implement? 1. Maintain a strict record of intake and output. 2. Insert a nasogastric (N/G) tube and begin saline lavage. 3. Assist the client with keeping a detailed calorie count. 4. Provide a quiet environment to promote rest. 254 Med-Surg SucceSS Colorectal Disease 37. The occupational health nurse is preparing a presentation to a group of factory workers about preventing colon cancer. Which information should be included in the presentation? 1. Wear a high-filtration mask when around chemicals. 2. Eat several servings of cruciferous vegetables daily. 3. Take a multiple vitamin every day. 4. Do not engage in high-risk sexual behaviors. 38. The nurse is admitting a client to a medical floor with a diagnosis of adenocarcinoma of the rectosigmoid colon. Which assessment data support this diagnosis? 1. The client reports up to 20 bloody stools per day. 2. The client has a feeling of fullness after a heavy meal. 3. The client has diarrhea alternating with constipation. 4. The client complains of right lower quadrant pain. 39. The 85-year-old male client diagnosed with cancer of the colon asks the nurse, “Why did I get this cancer?” Which statement is the nurse’s best response? 1. “Research shows a lack of fiber in the diet can cause colon cancer.” 2. “It is not common to get colon cancer at your age; it is usually in young people.” 3. “No one knows why anyone gets cancer, it just happens to certain people.” 4. “Women usually get colon cancer more often than men but not always.” 40. The nurse is planning the care of a client who has had an abdominal–perineal resection for cancer of the colon. Which interventions should the nurse implement? Select all that apply. 1. Provide meticulous skin care to stoma. 2. Assess the flank incision. 3. Maintain the indwelling catheter. 4. Irrigate the (JP) drains every shift. 5. Position the client semirecumbent. 41. The client who has had an abdominal perineal resection is being discharged. Which discharge information should the nurse teach? 1. The stoma should be a white, blue, or purple color. 2. Limit ambulation to prevent the pouch from coming off. 3. Take pain medication when the pain level is at an “8.” 4. Empty the pouch when it is one-third to onehalf full. 42. The nurse caring for a client one (1) day postoperative sigmoid resection notes a moderate amount of dark reddish brown drainage on the midline abdominal incision. Which intervention should the nurse implement first? 1. Mark the drainage on the dressing with the time and date. 2. Change the dressing immediately using sterile technique. 3. Notify the health-care provider immediately. 4. Reinforce the dressing with a sterile gauze pad. 43. The client complains to the nurse of unhappiness with the health-care provider. Which intervention should the nurse implement next? 1. Call the HCP and suggest he or she talk with the client. 2. Determine what about the HCP is bothering the client. 3. Notify the nursing supervisor to arrange a new HCP to take over. 4. Explain the client cannot request another HCP until after discharge. 44. The client with a new colostomy is being discharged. Which statement made by the client indicates the need for further teaching? 1. “If I notice any skin breakdown, I will call the HCP.” 2. “I should drink only liquids until the colostomy starts to work.” 3. “I should not take a tub bath until the HCP okays it.” 4. “I should not drive or lift more than five (5) pounds.” 45. The nurse is preparing to hang a new bag of total parenteral nutrition for a client with an abdominal perineal resection. The bag has 1,500 mL of 50% dextrose, 10 mL of trace elements, 20 mL of multivitamins, 20 mL of potassium chloride, and 500 mL of lipids. The bag is to infuse over the next 24 hours. At what rate should the nurse set the pump? _________ 46. The nurse is caring for clients in an outpatient clinic. Which information should the nurse teach regarding the American Cancer Society’s recommendations for the early detection of colon cancer? 1. Beginning at age 60, a digital rectal examination should be done yearly. 2. After reaching middle age, a yearly fecal occult blood test should be done. chapter 7 gaStrointeStinal diSorderS 255 3. Have a colonoscopy at age 50 and then once every five (5) to 10 years. 4. A flexible sigmoidoscopy should be done yearly after age 40. 47. The nurse writes a psychosocial problem of “risk for altered sexual functioning related to new colostomy.” Which intervention should the nurse implement? 1. Tell the client there should be no intimacy for at least three (3) months. 2. Ensure the client and significant other are able to change the ostomy pouch. 3. Demonstrate with charts possible sexual positions for the client to assume. 4. Teach the client to protect the pouch from becoming dislodged during sex. 48. The client presents with a complete blockage of the large intestine from a tumor. Which healthcare provider’s order would the nurse question? 1. Obtain consent for a colonoscopy and biopsy. 2. Start an IV of 0.9% saline at 125 mL/hr. 3. Administer 3 liters of GoLYTELY. 4. Give tap water enemas until it is clear. Diverticulosis/Diverticulitis 49. The client diagnosed with diverticulitis is complaining of severe pain in the left lower quadrant and has an oral temperature of 100.6°F. Which intervention should the nurse implement first? 1. Notify the health-care provider. 2. Document the findings in the chart. 3. Administer an oral antipyretic. 4. Assess the client’s abdomen. 50. The nurse is teaching the client diagnosed with diverticulosis. Which instruction should the nurse include in the teaching session? 1. Discuss the importance of drinking 1,000 mL of water daily. 2. Instruct the client to exercise at least three (3) times a week. 3. Teach the client about eating a low-residue diet. 4. Explain the need to have daily bowel movements. 51. The client is admitted to the medical unit with a diagnosis of acute diverticulitis. Which healthcare provider’s order should the nurse question? 1. Insert a nasogastric tube. 2. Start an IV with D5W at 125 mL/hr. 3. Put the client on a clear liquid diet. 4. Place the client on bedrest with bathroom privileges. 52. The nurse is discussing the therapeutic diet for the client diagnosed with diverticulosis. Which meal indicates the client understands the discharge teaching? 1. Fried fish, mashed potatoes, and iced tea. 2. Ham sandwich, applesauce, and whole milk. 3. Chicken salad on whole-wheat bread and water. 4. Lettuce, tomato, and cucumber salad and coffee. 53. The client is two (2) hours post colonoscopy. Which assessment data warrant intermediate intervention by the nurse? 1. The client has a soft, nontender abdomen. 2. The client has a loose, watery stool. 3. The client has hyperactive bowel sounds. 4. The client’s pulse is 104 and BP is 98/60. 54. The nurse is preparing to administer the initial dose of an aminoglycoside antibiotic to the client diagnosed with acute diverticulitis. Which intervention should the nurse implement? 1. Obtain a serum trough level. 2. Ask about drug allergies. 3. Monitor the peak level. 4. Assess the vital signs. 55. The client diagnosed with acute diverticulitis is complaining of severe abdominal pain. On assessment, the nurse finds a hard, rigid abdomen and T 102°F. Which intervention should the nurse implement? 1. Notify the health-care provider. 2. Prepare to administer a Fleet’s enema. 3. Administer an antipyretic suppository. 4. Continue to monitor the client closely. 56. The nurse is preparing to administer 250 mL of intravenous antibiotic to the client. The medication must infuse in one (1) hour. An intravenous pump is not available and the nurse must administer the medication via gravity with IV tubing at 10 gtts/min. At what rate should the nurse infuse the medication? _________ 57. The client with acute diverticulitis has a nasogastric tube draining green liquid bile. Which intervention should the nurse implement? 1. Document the findings as normal. 2. Assess the client’s bowel sounds. 3. Determine the client’s last bowel movement. 4. Insert the N/G tube at least two (2) more inches. 58. The nurse is teaching a class on diverticulosis. Which interventions should the nurse discuss when 256 Med-Surg SucceSS teaching ways to prevent an acute exacerbation of diverticulosis? Select all that apply. 1. Eat a high-fiber diet. 2. Increase fluid intake. 3. Elevate the HOB after eating. 4. Walk 30 minutes a day. 5. Take an antacid every two (2) hours. 59. The nurse is working in an outpatient clinic. Which client is most likely to have a diagnosis of diverticulosis? 1. A 60-year- old male with a sedentary lifestyle. 2. A 72-year- old female with multiple childbirths. 3. A 63-year- old female with hemorrhoids. 4. A 40-year-old male with a family history of diverticulosis. 60. The client is admitted to the medical floor with acute diverticulitis. Which collaborative intervention should the nurse anticipate the healthcare provider ordering? 1. Administer total parenteral nutrition. 2. Maintain NPO and nasogastric tube. 3. Maintain on a high-fiber diet and increase fluids. 4. Obtain consent for abdominal surgery. Gallbladder Disorders 61. The client is four (4) hours postoperative open cholecystectomy. Which data warrant immediate intervention by the nurse? 1. Absent bowel sounds in all four (4) quadrants. 2. The T-tube has 60 mL of green drainage. 3. Urine output of 100 mL in the past three (3) hours. 4. Refusal to turn, deep breathe, and cough. 62. The client two (2) hours postoperative laparoscopic cholecystectomy is complaining of severe pain in the right shoulder. Which nursing intervention should the nurse implement? 1. Apply a heating pad to the abdomen for 15 to 20 minutes. 2. Administer morphine sulfate intravenously after diluting with saline. 3. Contact the surgeon for an order to x-ray the right shoulder. 4. Apply a sling to the right arm, which was injured during surgery. 63. The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective? 1. “I will take my lipid-lowering medicine at the same time each night.” 2. “I may experience some discomfort when I eat a high-fat meal.” 3. “I need someone to stay with me for about a week after surgery.” 4. “I should not splint my incision when I deep breathe and cough.” 64. Which signs and symptoms should the nurse report to the health-care provider for the client recovering from an open cholecystectomy? Select all that apply. 1. Clay-colored stools. 2. Yellow-tinted sclera. 3. Amber-colored urine. 4. Wound approximated. 5. Abdominal pain. 65. The nurse is caring for the immediate postoper ative client who had a laparoscopic cholecystectomy. Which task could the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Check the abdominal dressings for bleeding. 2. Increase the IV fluid if the blood pressure is low. 3. Ambulate the client to the bathroom. 4. Auscultate the breath sounds in all lobes. 66. Which data should the nurse expect to assess in the client who had an upper gastrointestinal ( UGI) series? 1. Chalky white stools. 2. Increased heart rate. 3. A firm, hard abdomen. 4. Hyperactive bowel sounds. 67. The client is one (1) hour post–endoscopic retrograde cholangiopancreatogram (ERCP). Which intervention should the nurse include in the plan of care? 1. Instruct the client to cough forcefully. 2. Encourage early ambulation. 3. Assess for return of a gag reflex. 4. Administer held medications. 68. Which outcome should the nurse identify for the client scheduled to have a cholecystectomy? 1. Decreased pain management. 2. Ambulate first day postoperative. 3. No break in skin integrity. 4. Knowledge of postoperative care. 69. Which assessment data indicate to the nurse the client recovering from an open cholecystectomy may require pain medication? 1. The client’s pulse is 65 beats per minute. 2. The client has shallow respirations. 3. The client’s bowel sounds are 20 per minute. 4. The client uses a pillow to splint when coughing. 70. The charge nurse is monitoring client laboratory values. Which value is expected in the client with cholecystitis who has chronic inflammation? chapter 7 gaStrointeStinal diSorderS 257 1. An elevated white blood cell (WBC) count. 2. A decreased lactate dehydrogenase (LDH). 3. An elevated alkaline phosphatase. 4. A decreased direct bilirubin level