140 Unit 3 - Omness

c. Give the medications at 0900, and then the antacid at 1000. (Medications are not to be taken, unless prescribed, within 1 to 2 hours of taking an antacid because of the impact on the absorption of many medications in the stomach.)

0900, the nurse is about to give morning medications, and the patient has asked for a dose of antacid for severe heartburn. Which schedule for the antacid and medications is correct? a. Give both the antacid and medications at 0900. b. Give the antacid at 0900, and then the medications at 0930. c. Give the medications at 0900, and then the antacid at 1000. d. Give the medications at 0900, and then the antacid at 0915.

"I eat small meals during the day and have a bedtime snack." (GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.)

46-year-old female with gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement indicates that additional teaching about GERD is needed? "I take antacids between meals and at bedtime each night." "I sleep with the head of the bed elevated on 4-inch blocks." "I eat small meals during the day and have a bedtime snack." "I quit smoking several years ago, but I still chew a lot of gum."

"Do you use any recreational drugs or drink alcohol?" (A common etiologic factor for erectile dysfunction (ED) in younger men is use of recreational drugs or alcohol. Stress, priapism, and cardiovascular illness also contribute to ED, but they are not common etiologic factors in younger men.)

A 22-year-old man tells the nurse at the health clinic that he has recently had some problems with erectile dysfunction. Which question should the nurse ask first to assess for possible etiologic factors? "Do you experience an unusual amount of stress?" "Do you use any recreational drugs or drink alcohol?" "Do you have chronic cardiovascular or peripheral vascular disease?" "Do you have a history of an erection that lasted for 6 hours or more?"

Determining the source and type of food poisoning (Determining the source and type of food poisoning is essential to treatment, and is more important than determining other sick family members. Antibiotics are not normally indicated and immunizations are not relevant to diagnosis or treatment of food poisoning.)

A 23-year-old woman is brought to the ED complaining of stomach cramps, nausea, vomiting, and diarrhea. The care team suspects food poisoning. What is the key to treatment in food poisoning? Administering IV antibiotics Assessing immunization status Determining the source and type of food poisoning Determining if anyone else in the family is ill

"What factors led to your obesity?" (The nurse should obtain information about the patient's perceptions of the reasons for the obesity to develop a plan individualized to the patient. The other information also will be obtained from the patient, but the patient is more likely to make changes when the patient's beliefs are considered in planning.)

A 40-year-old obese woman reports that she wants to lose weight. Which question should the nurse ask first? "What factors led to your obesity?" "Which types of food do you like best?" "How long have you been overweight?" "What kind of activities do you enjoy?"

Obstructive sleep apnea (Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis. This patient's symptoms are not suggestive of laryngeal cancer.)

A 45-year-old obese man arrives in a clinic with complaints of daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of what health problem? Adenoiditis Chronic tonsillitis Obstructive sleep apnea Laryngeal cancer

ineffective role performance related to effects of ED. (The patient's statement indicates that the relationship with his wife is his primary concern. Although anxiety, low self-esteem, and ineffective sexuality patterns may also be concerns, the patient information suggests that addressing the role performance problem will lead to the best outcome for this patient.)

A 52-year-old man tells the nurse that he decided to seek treatment for erectile dysfunction (ED) because his wife "is losing patience with the situation." The most appropriate nursing diagnosis for the patient is situational low self-esteem related to effects of ED. ineffective role performance related to effects of ED. anxiety related to inability to have sexual intercourse. ineffective sexuality patterns related to infrequent intercourse.

"Have you taken any drugs like Viagra recently?" (Phosphodiesterase-5 inhibitors such as sildenafil (Viagra) relax smooth muscles to increase blood flow to the penis for treatment of erectile dysfunction. In combination with nitroglycerin, there can be extreme hypotension with reduction of blood flow to vital organs. The other questions are appropriate but not the highest priority before administering nitroglycerin.)

A 55-year-old male client is admitted to the emergency department with symptoms of a myocardial infarction. Which question by the nurse is the most appropriate before administering nitroglycerin? "On a scale from 0 to 10, what is the rating of your chest pain?" "Are you allergic to any food or medications?" "Have you taken any drugs like Viagra recently?" "Are you light-headed or dizzy right now?"

Ask the patient about any prescription drugs he is taking. (Because some medications can cause ED and patients using nitrates should not take sildenafil, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of sildenafil therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease.)

A 58-year-old man with erectile dysfunction (ED) tells the nurse he is interested in using sildenafil (Viagra). Which action should the nurse take first? Assure the patient that ED is common with aging. Ask the patient about any prescription drugs he is taking. Tell the patient that Viagra does not always work for ED. Discuss the common adverse effects of erectogenic drugs.

Replacement of fluids for those lost from vomiting and diarrhea (The therapeutic goal may be maintenance, replacement, treatment, diagnosis, monitoring, palliation, or a combination. This patient requires intravenous fluids for replacement of those lost from vomiting and diarrhea.)

A 58-year-old woman is suffering from food poisoning after eating at a local restaurant. She has had nausea, vomiting, and diarrhea for the past 12 hours. Her blood pressure is 88/50 and she is diaphoretic. She requires An access route to administer medications intravenously Replacement of fluids for those lost from vomiting and diarrhea An access route to replace fluids in combination with blood products Intravenous fluids to be administered on an outpatient basis

Assist with IV insertion by holding adipose tissue out of the way. (UAP can assist with IV placement by assisting with patient positioning or holding skinfolds aside. Planning for care and patient teaching require registered nurse (RN)-level education and scope of practice.)

A 61-year-old man is being admitted for bariatric surgery. Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP)? Demonstrate use of the incentive spirometer. Plan methods for bathing and turning the patient. Assist with IV insertion by holding adipose tissue out of the way. Develop strategies to provide privacy and decrease embarrassment.

breath sounds. (Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine.)

A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient's apical pulse. bowel sounds. breath sounds. abdominal girth.

b. Significant decrease in blood pressure (In patients with pre-existing cardiovascular disease, especially those on nitrates, erectile dysfunction drugs such as sildenafil lower blood pressure substantially, potentially leading to more serious adverse events. The other options are incorrect.)

A 73-year-old male patient is in the clinic for a yearly physical and is asking for a prescription for sildenafil (Viagra). He has listed on his health history that he is taking a nitrate for angina. The nurse is aware that which problem may occur if sildenafil is taken with a nitrate? a. Significant increase in pulse rate b. Significant decrease in blood pressure c. Increased risk of bleeding d. Reduced effectiveness of the sildenafil

c. Metabolic alkalosis (Excessive use of sodium bicarbonate may lead to systemic alkalosis. The other options are incorrect.)

A 75-year-old woman comes into the clinic with complaints of muscle twitching, nausea, and headache. She tells the nurse that she has been taking sodium bicarbonate five or six times a day for the past 3 weeks. The nurse will assess for which potential problem that may occur with overuse of sodium bicarbonate? a. Constipation b. Metabolic acidosis c. Metabolic alkalosis d. Excessive gastric mucus

indications that a thorough pain assessment should be done to determine the etiology of the pain, and the NTG should be given at once. (Responses to pain-relieving measures (e.g., NTG) help to differentiate between esophagitis and problems of cardiac origin (e.g., angina pectoris). If the nitroglycerin does relieve the pain, the physician should be notified because the patient indeed may be having a cardiac event.)

A client admitted for evaluation of gastroesophageal reflux disease (GERD) begins to complain of severe "heartburn" in the chest that radiates to the jaw. The client asks for the nitroglycerin (NTG) tablets brought in from home. The nurse realizes that the clinical manifestations demonstrated by the client are classic manifestations of a myocardial infarction, and the physician should be paged immediately. greatly influenced by fear related to the location of the pain, and the use of NTG should be discouraged. indications that a thorough pain assessment should be done to determine the etiology of the pain, and the NTG should be given at once. specifically associated with GERD and not myocardial infarction, but the NTG should be allowed if the client wants to use it.

"Carbon dioxide builds up while you are not breathing which stimulates your body to wake up and breathe." (The nurse's best response is related to the buildup of carbon dioxide stimulating the body to wake up and breathe. During sleep, the muscles relax and the tongue and neck structures are displaced with the tongue falling back, causing an upper airway obstruction. This obstruction leads to apnea and increased levels of carbon dioxide. Respiratory acidosis stimulates neural centers in the brain, and the client awakens, takes a deep breath, and goes back to sleep. After the client returns to sleep, the cycle may be repeated as often as every 5 minutes as the airway is re-obstructed.Too much carbon dioxide, not a lack of oxygen, is the trigger that causes the client to awaken and breathe. Telling the client he is choking is not accurate. The loud snoring is caused by partial upper airway obstruction by the tongue. Also, telling the client he isn't really awakening that often minimizes the client's concern and is not correct. The client may be awakening every 5 minutes as the cycle repeats.)

A client admitted for sleep apnea asks the nurse, "Why does it seem like I wake up every 5 minutes?" What is the nurse's best response? "Carbon dioxide builds up while you are not breathing which stimulates your body to wake up and breathe." "Because your body isn't getting enough oxygen you wake up and breathe." "Your tongue may be blocking your throat, and you wake up because you are choking." "You really aren't waking up that often. It just feels that way."

d. "There are three drugs currently approved for this." (There are three drugs available by prescription for weight loss, including orlistat (Xenical), lorcaserin (Belviq), and phentermine-topiramate (Qsymia). Suicidal thoughts are possible with lorcaserin and phentermine-topiramate. Orlistat is also available in a reduced-dose over-the-counter formulation.)

A client asks the nurse about drugs for weight loss. What response by the nurse is best? a. "All weight-loss drugs can cause suicidal ideation." b. "No drugs are currently available for weight loss." c. "Only over-the-counter medications are available." d. "There are three drugs currently approved for this."

Recent prostatectomy Long-term hypertension Diabetes mellitus Consumption of beer each night (Organic erectile dysfunction can be caused by surgical procedures, hypertension and its treatment, diabetes mellitus, and alcohol consumption. There is no evidence that exercise is related to this problem.)

A client came to the clinic with erectile dysfunction. What are some possible causes of this condition that the nurse could discuss with the client during history taking? (Select all that apply.) Recent prostatectomy Long-term hypertension Diabetes mellitus Hour-long exercise sessions Consumption of beer each night

"This type of gallbladder inflammation is associated with hypovolemia." (The nurse's best response about acalculous cholecystitis is that "This type of gallbladder inflammation is associated with hypovolemia."Although this type of gallbladder inflammation is associated with sepsis, it is not an indicator that sepsis is developing. Fibrotic and contracted gallstones are associated with chronic cholecystitis and this scenario states that there is no history of gallstones. The presence of acalculous cholecystitis is not an indicator that pancreatic disease has developed.)

A client diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? "This may be an indication that you are developing sepsis." "The gallstones are present, but have become fibrotic and contracted." "This type of gallbladder inflammation is associated with hypovolemia." "This may be an indication of pancreatic disease."

Antacids commonly interfere with the absorption of other drugs. (Antacids interfere with absorption of drugs such as anticholinergics, barbiturates, tetracycline, and digoxin. Liquid antacids are faster acting and more effective than antacid tablets. Antacids should be taken 1 or 2 hours after meals and at bedtime. Antacid tablets may be taken more frequently than every 4 hours.)

A client diagnosed with gastroesophageal reflux disease (GERD) is being treated with antacid therapy. When teaching the client about the therapy, what does the nurse reinforce? Antacids should be taken 1 hour before meals. These should be scheduled at 4-hour intervals. Antacid tablets are just as fast and effective as the liquid form. Antacids commonly interfere with the absorption of other drugs.

Fried chicken and buttered corn (Cholecystitis is often accompanied by intolerance to fatty foods, including fried foods and butter. Nuts and popcorn have a high fiber content but have less fat than fried foods; nuts and popcorn cause flatulence and pain for clients with lower intestinal problems, such as diverticulosis. Meatloaf and baked potato contain less fat than do fried foods or butter. Neither chocolate nor boiled seafood contains as much fat as fried chicken or butter.)

A client experiences occasional right upper quadrant pain attributed to cholecystitis. The nurse is providing discharge instructions, including a list of foods that cause dyspepsia. Which foods should be on the list the nurse provided the client? Nuts and popcorn Meatloaf and baked potato Chocolate and boiled shrimp Fried chicken and buttered corn

Divide the daily caloric intake into six smaller meals (The client's clinical manifestations are related to the dumping syndrome from the gastric bypass procedure. Smaller meals along with other interventions will help minimize this response. After gastric bypass, a bolus of hypertonic fluid enters the intestines before carbohydrates and electrolytes are diluted. Extracellular fluid is drawn into the bowel lumen; this causes a decrease in plasma volume, distention of the bowel lumen, and rapid intestinal transit. Protein intake should be increased, not decreased, to meet energy needs and promote healing. Fluids should be avoided at mealtimes because they increase the volume in the stomach and decrease the transit time of gastric contents moving from the stomach to the intestine, which contributes to dumping syndrome. An upright position decreases the transit time of gastric contents moving from the stomach to the intestines via gravity, which contributes to the dumping syndrome; clients may lie flat after eating for a short time.)

A client had a gastric bypass procedure to treat morbid obesity. After surgery the client reports weakness, sweating, palpitations, and dizziness after eating. What should the nurse encourage the client to do? Reduce the intake of protein-rich foods Drink 8 ounces (240 mL) of water with meals Divide the daily caloric intake into six smaller meals Remain in an upright position for one hour after eating

Coughing when eating or drinking (In Barrett's esophagus (a complication of gastroesophageal reflux disease [GERD]), fibrosis and scarring that accompany the healing process can cause esophageal stricture, leading to difficulty in swallowing. This can be manifested by coughing when the client eats or drinks and requires consultation with the health care team. The other assessments are typical of clients trying to control their GERD.)

A client has Barrett's esophagus. Which client assessment by the nurse requires consultation with the health care provider? Sleeping with the head of the bed elevated Coughing when eating or drinking Wanting to eat several small meals during the day Chewing antacid tablets frequently during the day

Wash hands with soap and water. (Alcohol does not kill C. difficile spores. Use of soap and water is more efficacious than alcohol-based hand rubs. Increased fluids and increased fiber do not decrease the risk of transmission of C. difficile.)

A client has Clostridium difficile. The nurse is providing discharge instructions related to decreasing the risk of transmission to family members. What would be appropriate to include in the client's teaching? Increase fluids. Increase fiber in the diet. Wash hands with soap and water. Wash hands with an alcohol-based hand sanitizer.

"I know I should drink at least 3 to 4 liters of fluid every day." (Dehydration contributes to the precipitation of minerals to form a stone. Ingestion of calcium or aspirin does not cause a stone. Antibiotics neither prevent nor treat a stone.)

A client has a history of renal calculi. Which statement by the client indicates a good understanding of preventive measures? "I know I should drink at least 3 to 4 liters of fluid every day." "I can't eat much dairy or other sources of calcium." "Aspirin and aspirin-containing products can lead to stones." "The doctor will give me antibiotics at the first sign of a stone."

Slow the feeding. (The most common cause of diarrhea during a feeding is dumping syndrome as a result of rapid feed infusion. Slowing the feeding is the appropriate initial action.)

A client has a large episode of diarrhea during an enteral feeding. What should be the first nursing action? Slow the feeding. Stop the feeding. Call the physician. Administer an antidiarrheal agent.

Asymmetric, tender flank area (Hydronephrosis, indicated by an asymmetric flank with tenderness, is commonly caused by obstruction such as a renal calculus. As the kidney continues to make urine, the volume of urine backs up into the kidney, increasing pressure, and the kidney is enlarged as a result. An asymmetric tender flank would be one manifestation of this condition. Polyuria, dysuria, and hypertension are not complications associated with renal calculi.)

A client has a large renal calculus. Which assessment finding may indicate the development of a complication? Blood pressure of 178/94 mmHg Urine output of 5600 mL/24 hr Client reports of pain on urination Asymmetric, tender flank area

A gnawing sensation relieved by food (The act of eating allows the hydrochloric acid in the stomach to work on and be neutralized by food rather than irritate the intestinal mucosa. An ache radiating to the left side is not specific to duodenal ulcers. An intermittent colicky flank pain may indicate renal colic. A generalized abdominal pain intensified by moving is not specific to duodenal ulcers.)

A client has a suspected peptic ulcer in the duodenum. What should the nurse expect the client to report when describing the pain associated with this disease? An ache radiating to the left side An intermittent colicky flank pain A gnawing sensation relieved by food A generalized abdominal pain intensified by moving

Metronidazole (Flagyl) (Metronidazole and vancomycin are the antibiotics of choice for C. difficile infection. Tylenol might be used if the client is febrile. The other two antibiotics are not appropriate.)

A client has been admitted with suspected Clostridium difficile infection. Which medication does the nurse plan to administer as a priority? Metronidazole (Flagyl) Acetaminophen (Tylenol) Tetracycline (Sumycin) Doxycycline (Vibramycin)

a. "Increase the fiber and water in your diet." (This drug can cause constipation, so the client should increase fiber and water in the diet to prevent this from occurring. Reducing fat in the diet is important with orlistat. Lorcaserin can cause dry mouth but not decreased sweating. Loose stools are common with orlistat.)

A client has been prescribed lorcaserin (Belviq). What teaching is most appropriate? a. "Increase the fiber and water in your diet." b. "Reduce fat to less than 30% each day." c. "Report dry mouth and decreased sweating." d. "Lorcaserin may cause loose stools for a few days."

a. Arrange a dietary consult. (The client with dumping syndrome after a gastrectomy has multiple dietary needs. A referral to the registered dietitian will be extremely helpful. Food and fluid intake is complicated and needs planning. The client should not be NPO.)

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful? a. Arrange a dietary consult. b. Increase fluid intake. c. Limit the client's foods. d. Make the client NPO.

a. Canned unsweetened apricots d. Potato soup (Canned apricots and potato soup are appropriate selections as they are part of a high-protein, high-fat, low- to moderate-carbohydrate diet. Coffee cake and other sweets must be avoided. Milk products and sweet drinks such as shakes must be avoided. Gas-forming foods such as broccoli must also be avoided.)

A client has dumping syndrome. What menu selections indicate the client understands the correct diet to manage this condition? (Select all that apply.) a. Canned unsweetened apricots b. Coffee cake c. Milk shake d. Potato soup e. Steamed broccoli

gastroesophageal reflux disorder. (In GERD, the cardiac sphincter relaxes, allowing gastric acid to enter the esophagus. The secretions may be allowed to enter the larynx, causing chemical irritation. Chronic irritation can lead to bouts of laryngitis. The other three options are not related.)

A client has frequent bouts of laryngitis. When assessing the client the nurse should specifically ask questions regarding the presence of a family history of idiopathic hoarseness. frequent upper respiratory tract infections. gastroesophageal reflux disorder. a history of stomach cancer.

c. Omeprazole (Prilosec) (Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and ranitidine are histamine blockers. Maalox is an antacid.)

A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a. Famotidine (Pepcid) b. Magnesium hydroxide (Maalox) c. Omeprazole (Prilosec) d. Ranitidine (Zantac)

Providing six small feedings daily and offering fluids frequently (The nursing intervention with the highest priority to prevent dehydration in a post-operative bariatric client is small daily feedings and adequate fluids. This will prevent the development of dehydration in this client.Ambulation will prevent pulmonary embolism and other circulatory problems. An abdominal binder will help support the abdomen and may prevent dehiscence of the wound. Observing for tachycardia, nausea, diarrhea, and abdominal cramping will prevent the development of postoperative dumping syndrome. All of these interventions are important, but preventing dehydration is the priority.)

A client has undergone bariatric surgery. Which nursing intervention is the highest priority in preventing dehydration in this client? Ambulating the client as quickly as possible after surgery Applying an abdominal binder daily when the client is out of bed Observing for tachycardia, nausea, diarrhea, and abdominal cramping Providing six small feedings daily and offering fluids frequently

Whole bran (Whole bran provides bulk that promotes intestinal motility and a regular bowel movement. Vitamins are not related to normalizing bowel function. Cod liver oil is not related to regulating bowel function. Amino acids are not related to regulating bowel function.)

A client is admitted to the hospital for a laparoscopic cholecystectomy. What should the nurse encourage the client to add to the diet to help normalize bowel function after surgery? Vitamins Whole bran Cod liver oil Amino acids

Hemorrhage (Hemorrhage because of erosion of blood vessel walls is the most common complication of peptic ulcer disease. The complication of gastric perforation usually occurs after, and is not as common as, hemorrhage. Pyloric obstruction is not a common complication of peptic ulcer disease. Esophageal varices occur with portal hypertension, not peptic ulcer disease.)

A client is admitted to the hospital with a diagnosis of peptic ulcer. Which most common complication should the nurse assess for in this client? Perforation Hemorrhage Pyloric obstruction Esophageal varices

"Are you taking any antibiotics?" (Infection with C. difficile is a bacterial dysentery often seen in clients who have been receiving large doses of antibiotics or who have taken antibiotics over a long period.)

A client is admitted with dysentery caused by Clostridium difficile, or pseudomembranous colitis. To elicit the most helpful information about the cause of the dysentery, the nurse would ask the client "Are you taking any antibiotics?" "Do you ever go barefoot outside your home?" "Does anyone else in your family have bowel problems?" "Have you traveled in any foreign countries lately?"

Blood in the urine Frequency and urgency of urination (Hematuria is a common clinical manifestation of renal calculi. Frequency and a sense of urgency may occur because of irritation caused by the calculi; the most common expectation is sharp, severe pain. Irritability may occur because of discomfort; twitching does not occur. Pyuria may occur when infection is present; skin problems do not occur. Pain radiates from the flank to the groin area.)

A client is admitted with renal calculi. Which clinical manifestations does a nurse expect the client to report? Select all that apply. Blood in the urine Irritability and twitching Dry, itchy skin and pyuria Frequency and urgency of urination Pain radiating from the kidney to a shoulder

b. Beginning venous thromboembolism prophylaxis (Morbidly obese clients are at high risk of venous thromboembolism and should be started on a regimen to prevent this from occurring as a priority. Answering questions about the surgery is done by the surgeon. Teaching is important, but safety comes first.)

A client is awaiting bariatric surgery in the morning. What action by the nurse is most important? a. Answering questions the client has about surgery b. Beginning venous thromboembolism prophylaxis c. Informing the client that he or she will be out of bed tomorrow d. Teaching the client about needed dietary changes

eating food and drinking beverages prepared in the foreign country. (Giardiasis results from a Giardia organism that attacks the gastrointestinal system. It is contracted from ingesting contaminated food and water in areas where sanitation is suspect.)

A client is taking a 3-week diving vacation in a foreign country and will be staying at a local hotel known for its native food. The nurse cautions the client that a common traveler's infection is giardiasis, and that the client should be cautious about eating food and drinking beverages prepared in the foreign country. flying on an airplane in close contact with other persons. swimming in the coastal waters of the foreign country. taking the necessary inoculations required to travel.

Hypoventilation syndrome (Ventilation insufficiency occurs in response to inadequate chest wall expansion caused by weight of adipose tissue on the rib cage and the body's need for oxygen to all body cells. Diarrhea, distention, and abdominal cramps often occur in the postoperative period after gastric bypass in response to the hyperosmolar shift of fluid from the intravascular compartment into the intestine in response to rapid emptying of hyperosmolar food without usual dilution in the stomach; this fluid shift initiates the systemic response of weakness, tachycardia, and diaphoresis. Compartment syndrome generally is a complication of trauma; increased pressure within the limited anatomic space (e.g., muscle compartment) contributes to decreased microcirculation, which causes nerve and muscle anoxia and necrosis of tissue. Inappropriate antidiuretic hormone syndrome is excessive secretion of ADH, a hypo-osmolar state with a dilutional hyponatremia; the most common cause is oat cell carcinoma of the lung, in addition to other malignant tumors that produce ADH.)

A client is being considered for bariatric surgery. Which client health problem does the nurse identify as consistent with morbid obesity? Dumping syndrome Compartment syndrome Hypoventilation syndrome Inappropriate antidiuretic hormone syndrome (ADH)

Dark brown or black (Dark brown or black stools (melena) indicate gastrointestinal bleeding and need to be reported. Frothy stools are indicative of inadequate fat absorption and are associated with sprue. Ribbon-shaped stools indicate a bowel mass or obstruction. Clay-colored stools usually are related to problems that cause a decrease in bile.)

A client is diagnosed with a peptic ulcer. When teaching about peptic ulcers, the nurse instructs the client to report what kind of stools? Frothy Ribbon shaped Pale or clay colored Dark brown or black

Gastric culture (A gastric culture enables the healthcare provider to identify the presence of Helicobacter pylori. Two thirds of individuals with gastric or duodenal ulcers are infected with this organism. A barium enema outlines structural changes in the lower gastrointestinal tract; it will not outline the stomach or duodenum. A gastric biopsy is done to identify the presence of malignant cells. A stool examination may identify melena or parasites, but it is not definitive for peptic ulcers.)

A client is evaluated at a clinic, and the healthcare provider suspects that the client has anemia and a peptic ulcer. To determine if the client has a peptic ulcer, the nurse expects that what diagnostic test will be performed? Barium enema Gastric biopsy Gastric culture Stool examination

a. Consult with the provider about obtaining stool cultures. (Hospitalized clients who have three or more stools a day for 2 or more days are suspected of having infection with Clostridium difficile. The nurse should inform the practitioner and request stool cultures. Frequent perianal care is important and can be delegated but is not the priority. The client does not necessarily need to be NPO; if the client is NPO, the nurse ensures he or she is getting appropriate IV fluids to prevent dehydration. Anti-diarrheal medication may or may not be appropriate, and the diarrhea serves as the portal of exit for the infection.)

A client is hospitalized and on multiple antibiotics. The client develops frequent diarrhea. What action by the nurse is most important? a. Consult with the provider about obtaining stool cultures. b. Delegate frequent perianal care to unlicensed assistive personnel. c. Place the client on NPO status until the diarrhea resolves. d. Request a prescription for an anti-diarrheal medication.

a. Assess the client's coping and support systems. (The nurse should assess this client's coping styles and support systems in order to provide holistic care. The other options do not address the client's distress.)

A client is in the bariatric clinic 1 month after having gastric bypass surgery. The client is crying and says "I didn't know it would be this hard to live like this." What response by the nurse is best? a. Assess the client's coping and support systems. b. Inform the client that things will get easier. c. Re-educate the client on needed dietary changes. d. Tell the client lifestyle changes are always hard.

a. Ask the client if the weight loss was intentional. (This client has had a 12% weight loss. The nurse first determines if the weight loss was intentional. If not, then the nurse proceeds to a comprehensive nutritional assessment. Food intolerances are part of this assessment. Depending on risk factors and other findings, a blood glucose test may be warranted.)

A client is in the family practice clinic. Today the client weighs 186.4 pounds (84.7 kg). Six months ago the client weighed 211.8 pounds (96.2 kg). What action by the nurse is best? a. Ask the client if the weight loss was intentional. b. Determine if there are food allergies or intolerances. c. Perform a comprehensive nutritional assessment. d. Perform a rapid bedside blood glucose test.

Loose stools, abdominal cramps, and nausea (The nurse tells the client to expect loose stools, abdominal cramps, and nausea. These are side effects unique to orlistat (Xenical).Dry mouth, constipation, and insomnia are not side effects of orlistat. Insomnia, dry mouth, blurred vision, palpitations, constipation, and restlessness are all side effects of short-term therapy drugs such as phentermine (Adipex-P), diethylpropion (Tenuate), and phendimetrazine (Bontril).)

A client is placed on orlistat (Xenical) as part of a treatment regimen for morbid obesity. What side effects does the nurse tell the client to expect from using this drug? Dry mouth, constipation, and insomnia Insomnia, dry mouth, and blurred vision Loose stools, abdominal cramps, and nausea Palpitations, constipation, and restlessness

Stores and concentrates bile (The gallbladder concentrates and stores about 90 mL of bile, which is discharged in response to the entrance of fatty food into the duodenum. The gallbladder releases bile into the cystic duct. The common bile duct is connected directly to the pancreas. The sphincter of Oddi controls the release of bile into the duodenum; dietary fat progresses from the stomach to the duodenum and then to the rest of the intestinal tract.)

A client is scheduled for a cholecystectomy and asks the primary nurse about the function of the gallbladder. What should the nurse identify is the function of the gallbladder when providing preoperative teaching? Stores and concentrates bile Releases bile into the pancreatic duct Connects the common bile duct and the pancreas Controls the flow of fat through the sphincter of Oddi

c. Ensure an adequate airway. (All actions are appropriate care measures for this client; however, airway is always the priority. Bariatric clients tend to have short, thick necks that complicate airway management.)

A client just returned to the surgical unit after a gastric bypass. What action by the nurse is the priority? a. Assess the client's pain. b. Check the surgical incision. c. Ensure an adequate airway. d. Program the morphine pump.

Prednisone (Prednisone is a corticosteroid that suppresses inflammatory responses. A side effect of prednisone is the development of peptic ulcers. Azathioprine is an immunosuppressant that may cause anemia. Cyclosporine is an immunosuppressant that may cause nephrotoxicity and hypertension. Cyclophosphamide is an immunosuppressant that may cause hemorrhagic cystitis.)

A client on immunosuppressive therapy is diagnosed with a peptic ulcer. Which medication might have led to this condition? Prednisone Azathioprine Cyclosporine Cyclophosphamide

Electrolyte imbalance (The stomach produces about 3 L of secretions per day. Fluid lost through vomiting can produce inadequate fluid volume and electrolyte imbalance, which can lead to dysrhythmias and death. Although pain is associated with gastric ulcers and requires intervention, it is not life threatening as is an electrolyte imbalance. Although the risk for injury is a concern, it is not the priority. Although respirations may be shallow when the client is experiencing pain, this is not the priority.)

A client presents with gastric pain, vomiting, dehydration, weakness, lethargy, and shallow respirations. Laboratory results indicate metabolic alkalosis. The diagnosis of gastric ulcer has been made. What is the primary nursing concern? Chronic pain Risk for injury Electrolyte imbalance Inadequate gas exchange

Vomiting relieves pain. Pain is described as gnawing. Pain occurs half an hour after meals. (Vomiting removes gastric hydrochloric acid (HCl), which irritates the ulcer and causes pain. Typically, gastric ulcer pain is described as burning or gnawing. Eating causes the secretion of HCl, which increases pain. Eating causes the secretion of HCl, which increases, not relieves, pain. Flatulence is not related to a gastric ulcer.)

A client reports pain as a result of a gastric ulcer. What clinical findings is the nurse most likely to identify during an assessment of the client's pain? Select all that apply. Vomiting relieves pain. Eating food prevents pain. Pain is described as gnawing. Flatulence accompanies pain. Pain occurs half an hour after meals.

c. Psychosocial influences on weight (While all topics might be important to assess, people who lose and gain weight in cycles often are depressed or have poor self-esteem, which has a negative effect on weight-loss efforts. The nurse assesses the client's psychosocial status as the priority.)

A client tells the nurse about losing weight and regaining it multiple times. Besides eating and exercising habits, for what additional data should the nurse assess as the priority? a. Economic ability to join a gym b. Food allergies and intolerances c. Psychosocial influences on weight d. Reasons for wanting to lose weight

Methylprednisolone (Methylprednisolone is a corticosteroid that suppresses inflammatory responses and inhibits both cytokine production and T-cell activation. This drug may cause a peptic ulcer, osteoporosis, and hypertension. Everolimus may cause urinary tract infections, hyperlipidemia, and peripheral edema. Azathioprine may cause bone marrow suppression, neutropenia, and thrombocytopenia. Mycophenolate acid may cause diarrhea, neutropenia, and increased incidence of malignancies.)

A client undergoing corticosteroid therapy is admitted with a peptic ulcer, osteoporosis, and hypertension. Which medication may have caused this condition? Everolimus Azathioprine Mycophenolate acid Methylprednisolone

"Taking an antacid preparation will decrease pain due to gastric acid." (Over-the-counter antacid preparations neutralize gastric acid and relieve pain. Although eating food initially prevents gastric acid from irritating the gastric walls, it can precipitate acid production. Aspirin is contraindicated because it irritates gastric mucosa and promotes bleeding by preventing platelet aggregation. Reduction of fluids with meals does not affect pain.)

A client who has a gastric ulcer asks what to do if epigastric pain occurs. The nurse evaluates that teaching is effective when the client makes which statement? "Eliminating fluids with meals will prevent pain." "I will increase my food intake to avoid an empty stomach." "Taking an aspirin with milk will relieve my pain and coat my ulcer." "Taking an antacid preparation will decrease pain due to gastric acid."

b. Enzyme-linked immunosorbent assay (ELISA) toxin A+B (Clients taking antibiotics are at risk for Clostridium difficile infection. The most common test for this disorder is a stool sample for ELISA toxin A+B. Colonoscopy, ova and parasites, and stool culture are not warranted at this time.)

A client who has been taking antibiotics reports severe, watery diarrhea. About which test does the nurse teach the client? a. Colonoscopy b. Enzyme-linked immunosorbent assay (ELISA) toxin A+B c. Ova and parasites d. Stool culture

"I will need to continue to watch my diet and may still need medication." (A high percentage of recurrence of reflux has been noted after this type of surgery, so clients are encouraged to continue anti-reflux regimens of medication and diet control. These include taking medications, eating small meals, and avoiding spicy or acidic foods.)

A client who has undergone Nissen fundoplication for gastroesophageal reflux disease (GERD) is ready for discharge home. Which statement made by the client indicates understanding of the disease? "I will no longer need any medication for my GERD." "I will avoid spicy foods because they can irritate the suture line." "I should take anti-reflux medications when I eat a large meal." "I will need to continue to watch my diet and may still need medication."

Using a weight-rated extra-wide bed for the client (The most effective way to reposition a post-operative bariatric client and prevent injury is to use a special weight-related extra wide bed. This will allow adequate room for re-positioning the client comfortably without causing the bed rails to touch his or her body, causing pressure and injury.Pain medication and monitoring skinfold areas will not prevent injury to the client that might occur during repositioning. Not moving the client's NG tube will prevent disruption of the suture line, but will not prevent repositioning injuries.)

A client who has undergone a bariatric surgical procedure is recuperating after surgery. Which nursing intervention most effectively prevents injury to the client who is being re-positioned postoperatively? Administering pain medication Making sure not to move the client's nasogastric (NG) tube Monitoring skinfold areas and keeping them clean and dry Using a weight-rated extra-wide bed for the client

d. Heartburn (The onset of GERD symptoms may be sudden or gradual. Patients typically report a painful burning sensation that moves up and down, commonly occurs after meals, and is relieved by antacids. Acid regurgitation, intermittent dysphagia, and belching are also common.)

A home health nurse is assigned to follow-up on a patient recently diagnosed with gastroesophageal reflux disease (GERD). Which primary symptom should the nurse take into consideration when updating the nursing interventions on this patient's care plan? a. Nausea b. Vomiting c. Anorexia d. Heartburn

"Most peptic ulcers heal with medical treatment." (Treatment with medications, rest, diet, and stress reduction relieves symptoms, heals the ulcer, and prevents complications and recurrence. Clients with duodenal ulcers have pain after eating and especially at night; gastric ulcers cause pain during or close to eating. Surgery may be done after multiple recurrences and for treating complications. Perforation, pyloric obstruction, and hemorrhage, not cancer, are major complications.)

A client who is diagnosed with a duodenal ulcer asks, "Now that I have an ulcer, what comes next?" What is the nurse's best response? "Most peptic ulcers heal with medical treatment." "Clients with peptic ulcers have pain while eating." "Early surgery is advisable, especially after the first attack." "If ulcers are untreated, cancer of the stomach can develop."

Weakness Diaphoresis Tachycardia Cold extremities (The stress ulcer can bleed, leading to shock. Weakness is related to the decrease in the oxygen-carrying capacity of the blood associated with shock. Diaphoresis and tachycardia are sympathetic nervous system responses associated with shock. Peripheral vasoconstriction is associated with the sympathetic nervous system response associated with shock and leads to cold extremities. The skin will be pale, rather than flushed, because of peripheral vasoconstriction.)

A client who sustained serious burns now has a stress ulcer. Which clinical indicators should the nurse immediately report to the primary healthcare provider? Select all that apply. Weakness Diaphoresis Tachycardia Cold extremities Flushed skin tone

Lack of weight-bearing activity promotes bone demineralization. (All clients who are confined to bed for any considerable period risk losing calcium from bones. Calcium precipitates in the urine, resulting in formation of calculi. There is no indication that the client's diet has changed. Although the client may have more difficulty urinating in a supine position because of an inability to assume the preferred anatomic position and the emotional effects of using a urinal, it usually does not predispose the client to developing renal calculi. The presence of a healing fracture does not increase total calcium metabolism; however, deposition of bone at the fracture site will be increased.)

A client with a femoral fracture associated with osteomyelitis is immobilized for 3 weeks. The nurse assesses for the development of renal calculi. What is the rationale for the nurse's assessment? The client's dietary patterns have changed since admission. The client has more difficulty urinating in a supine position. Lack of weight-bearing activity promotes bone demineralization. Fracture healing requires more calcium, which increases total calcium metabolism.

Coughing and deep breathing (The operative site's proximity to the diaphragm results in the client taking shallow respirations to limit pain; failure to expand the lungs can cause hypostatic pneumonia. The healthcare provider explores possible complications when providing information for an informed consent. The nurse should not emphasize possible complications because it may increase the client's anxiety. Preoperative teaching should focus on the interventions that prevent complications. Food and fluid restrictions should be included in preoperative teaching; however, this is not the priority. Isometric exercises of the extremities are unnecessary; the client will be allowed out of bed within several hours after surgery.)

A client with a history of recurrent cholecystitis is scheduled for an abdominal cholecystectomy. What should the nurse specifically emphasize when planning preoperative teaching for this client? Possible complications Food and fluid restrictions Coughing and deep breathing Isometric exercises of the extremities

Listening to breath sounds (Administration of opioids increases risk for airway obstruction postoperatively. Clients will desaturate as revealed by a drop in oxygen saturation by pulse oximetry. The remaining options are not as specific for this particular client's risk.)

A client with a history of sleep apnea has had a same-day surgery procedure that will require the administration of morphine postoperatively to manage pain. This client will be assessed most appropriately by the perioperative nurse for the risk for respiratory complications by frequently: Listening to breath sounds Monitoring pulse oximetry Evaluating spirometer use Counting respirations per minute

Semi-Fowler (The semi-Fowler position will localize the spilled stomach contents in the lower part of the abdominal cavity. The Sims position will exert pressure on the abdomen, which may be uncomfortable for the client. Lying flat in bed exerts pressure against the diaphragm from abdominal organs; this will inhibit breathing and intensify discomfort. Also, it allows spilled stomach contents to spread throughout the abdominal cavity. The dorsal recumbent position exerts pressure against the diaphragm from abdominal organs; this will inhibit breathing and intensify discomfort. Also, this position allows spilled stomach contents to spread throughout the abdominal cavity.)

A client with a rigid and painful abdomen is diagnosed with a perforated peptic ulcer. A nasogastric tube is inserted, and surgery is scheduled. Before surgery, the nurse should place the client in what position? Sims Flat-lying Semi-Fowler Dorsal recumbent

Obtaining the admission weight, height, and vital signs (Obtaining admission height, weight, and vital signs is included in the education for UAPs and usually is included in the job description for these staff members.Assessing for risk factors, checking bowel sounds, and determining precipitating factors for abdominal pain require assessment skills. Assessment skills require broader education and are within the scope of practice of licensed nursing staff and not UAPs.)

A client with acute cholecystitis is admitted to the medical-surgical unit. Which nursing activity associated with the client's care will be appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? Assessing dietary risk factors for cholecystitis Checking for bowel sounds and distention Determining precipitating factors for abdominal pain Obtaining the admission weight, height, and vital signs

Opioids will be available for postoperative pain. (Painful biliary colic may occur in the postoperative period as a result of the passage of pulverized fragments of the calculi; this may occur three or more days after the lithotripsy. Fever may indicate pancreatitis, which is a rare occurrence. The delivery of shock waves during the procedure is synchronized with the heartbeat to avoid initiation of dysrhythmias. Light sedation may be used to keep the client comfortable and as still as possible.)

A client with cholelithiasis is scheduled for a lithotripsy. What should the nurse include in the client's teaching plan? Opioids will be available for postoperative pain. Fever is a common response to this intervention. Heart palpitations often occur after the procedure. Anesthetics are not necessary during the procedure.

To treat Helicobacter pylori infection (Approximately two thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion.)

A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole. What purpose does the nurse provide? To augment the immune response To potentiate the effect of antacids To treat Helicobacter pylori infection To reduce hydrochloric acid secretion

Nizatidine Ranitidine Famotidine (Nizatidine is an H₂ receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Ranitidine is an H₂ receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Famotidine is an H₂ receptor antagonist that reduces gastric acid secretion and provides for symptomatic improvement in GERD. Lansoprazole is a proton pump inhibitor that inhibits gastric secretion up to 90% with one dose daily and provides for symptomatic improvement in GERD. Metoclopramide is a prokinetic agent that increases the rate of gastric emptying; it has multiple side effects and is not appropriate for long-term treatment of GERD.)

A client with gastroesophageal reflux disease (GERD) receives a prescription for an H₂ receptor antagonist. Which medications are within the classification of an H₂ receptor antagonist? Select all that apply. Nizatidine Ranitidine Famotidine Lansoprazole Metoclopramide

Encourage to quit smoking Avoid caffeine-containing products Avoid lying down for 2 to 3 hours after eating (Smoking cessation should be encouraged. Caffeine should be avoided because it decreases esophageal sphincter pressure, which permits reflux. Advise the client not to lie down for 2 to 3 hours after eating. Coffee and tea contain caffeine, which decreases esophageal sphincter pressure and should be avoided; milk does not have to be eliminated from the diet unless the client has lactose intolerance. The head, not the foot, of the bed should be elevated to prevent nighttime reflux; at night infrequent swallowing and the recumbent position impair esophageal clearance. Three large meals increase the volume pressure in the stomach, which delays gastric emptying; four to six smaller meals are preferred.)

A client with gastroesophageal reflux disease (GERD) should make diet and lifestyle changes. Which instructions should the nurse include in the client's discharge teaching? Select all that apply. Encourage to quit smoking Elevate the foot of the bed Avoid caffeine-containing products Eat three large, evenly spaced meals daily Avoid lying down for 2 to 3 hours after eating

Elevate the head of the bed on blocks. (Elevating the head of the bed on blocks raises the upper torso and minimizes reflux of gastric contents. Increasing the content of the stomach before lying down will aggravate the symptoms associated with gastroesophageal reflux. Eliminating carbohydrates from the diet will have no effect on the reflux of gastric contents. The effect of antacids is not long-lasting enough to promote a full night's sleep; sodium bicarbonate is not recommended as an antacid.)

A client with gastroesophageal reflux disease reports having difficulty sleeping at night. What should the nurse instruct the client to do? Drink a glass of milk before retiring. Elevate the head of the bed on blocks. Eliminate carbohydrates from the diet. Take antacids, such as sodium bicarbonate.

Metronidazole (Metronidazole is the first line of treatment prescribed to clients with a Clostridium difficile infection. Rifaximin is used to treat traveler's diarrhea caused by Escherichia coli. Fidaxomicin is reserved for clients who are at risk for the relapse of or have recurrent Clostridium difficile infections. Vancomycin is preferred for serious Clostridium difficile infections.)

A client with mild diarrhea is diagnosed with a Clostridium difficile infection. Which is the first-line drug that would be used to treat this condition? Rifaximin Fidaxomicin Vancomycin Metronidazole

b. "Slippery elm is often used for this disorder." (There are several complementary and alternative medicine regimens that are used for gastritis and peptic ulcer disease. Most have been tested on animals but not humans. Slippery elm is a common supplement used for this disorder.)

A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. What response by the nurse is best? a. "Slippery elm has no benefit for this problem." b. "Slippery elm is often used for this disorder." c. "There is no evidence that this will work." d. "You should not take any herbal remedies."

c. Start a large-bore IV with normal saline. (This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse should start a large-bore IV with isotonic solution. Ibuprofen will exacerbate the ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the priority.)

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? a. Administer ibuprofen (Motrin). b. Call the Rapid Response Team. c. Start a large-bore IV with normal saline. d. Tell the client to remain lying down.

Obtain an order for omeprazole twice daily. (Omeprazole is a proton pump inhibitor that acts to reduce gastric acid secretion. If once-daily dosing fails to control the client's symptoms, the nurse should obtain an order for the client to take omeprazole twice daily for better symptom control. This finding should be documented, but the nurse should do more than merely record the client's symptoms. Doubling the daily dose and adding antacids will not be as effective as obtaining an order for twice-a-day dosing.)

A client with severe gastroesophageal reflux disease (GERD) is still having symptoms of reflux despite taking omeprazole, (Prilosec) 20 mg daily. What does the nurse do next? Document the finding in the client's chart. Obtain an order for omeprazole twice daily. Instruct the client to double the daily dose. Tell the client to take antacids with omeprazole.

a. Angina pectoris (Patient with angina usually are treated with nitrates; phosphodiesterase inhibitors such as tadalifil are contraindicated in patients taking nitrates.)

A male patient wants to begin taking tadalifil (Cialis) to treat erectile dysfunction. Which aspect of this patient's history would be of concern? a. Angina pectoris b. Asthma c. Benign prostatic hypertrophy d. Color blindness

Ask the client whether the mask fits tightly over the mouth and nose. (Assessment is the first step of the nursing process. The nurse should assess whether the mask fits tightly over the mouth and nose and if the client has been consistently using CPAP at night, as initial adjustments to this therapy may be needed.With APAP, the pressures are adjusted continuously depending on the client's needs; this may be more comfortable for the client. Modafinil treats narcolepsy or daytime sleepiness; it does not correct the cause of sleep apnea, but may be used to help some of the side effects of obstructive sleep apnea. A nasal mask may be an option for the client if the facemask used with CPAP is uncomfortable.)

A client with sleep apnea who has a new order for continuous positive airway pressure (CPAP) with a facemask returns to the outpatient clinic after 2 weeks with a report of ongoing daytime sleepiness. Which action should the nurse take first? Ask the client whether the mask fits tightly over the mouth and nose. Discuss the use of autotitrating positive airway pressure (APAP). Plan to teach the client about treatment with modafinil (Provigil). Suggest that a nasal mask be used instead of a full facemask.

a. pain and distention after eating. (A clinical symptom of gallbladder inflammation is pain and distention after eating. When infection, stones, or both are present, the normal contraction of the gallbladder, triggered by fat entering the intestine, causes pain.)

A clinical symptom of gallbladder inflammation or gallstones is a. pain and distention after eating. b. jaundice. c. anorexia. d. weakness and apathy.

Obtain appropriately sized equipment for these clients. (All actions might be appropriate and helpful in the care of bariatric clients. However, staff and client safety is a unique priority when working with this group of clients. The manager must ensure appropriately sized equipment, so that neither staff nor clients injure themselves.)

A facility is beginning to perform bariatric surgery on obese clients. Which action by the nursing manager is most important? Obtain appropriately sized equipment for these clients. Select a dedicated group of staff members for these clients. Send personnel to sensitivity training as part of orientation. Establish multidisciplinary rounding for clients in this program.

"Tell me about any changes in your menstrual cycle each month." (The best response by the nurse is to ask the client who is concerned about her inability to conceive, is to ask her about changes in her menstrual cycle each month. Obesity has been known to produce changes in the menstrual cycle, thus causing difficulties in getting pregnant. Asking the client about her menstrual cycle directly addresses the client's concern and is designed to elicit helpful assessment information.Asking the client if she feels her obesity is keeping her from getting pregnant only asks the client to restate the obvious. It is also a closed question that requires only a "yes-or-no" response. Telling the client that adoption is an option is an intrusive response by the nurse and may alienate the client. It also does not address the client's concern about obesity. Asking what her health care provider told her is an evasive response from the nurse and does not address the client's concerns.)

A female client is concerned that her inability to conceive a child is connected to her morbid obesity. How does the nurse respond? "Do you feel that your obesity is keeping you from getting pregnant?" "Have you considered adoption as an option?" "Tell me about any changes in your menstrual cycle each month." "What has your health care provider told you about your problems in getting pregnant?"

"Cosmetic surgery is a possibility once your weight has stabilized." (Reconstructive surgery may be used to eliminate excess skinfolds after at least a year has passed since the surgery. Skinfolds may not disappear over time, especially in older patients. The response, "The important thing is that your weight loss is improving your health," ignores the patient's concerns about appearance and implies that the nurse knows what is important. Whereas it may be helpful for the patient to talk to a counselor, it is more likely to be helpful to know that cosmetic surgery is available.)

A few months after bariatric surgery, a 56-year-old man tells the nurse, "My skin is hanging in folds. I think I need cosmetic surgery." Which response by the nurse is most appropriate? "The important thing is that you are improving your health." "The skinfolds will disappear once most of the weight is lost." "Cosmetic surgery is a possibility once your weight has stabilized." "Perhaps you would like to talk to a counselor about your body image."

a. cheese and whole grain crackers. (The complex of symptoms in dumping syndrome constitutes a shock syndrome that results when a meal containing a large portion of readily soluble carbohydrates rapidly enters, or "dumps," into the small intestine. An appropriate food choice for someone with dumping syndrome would include complex carbohydrate and protein as well as fat—in this case, cheese and whole grain crackers. Nonfat milk and pretzels would not provide any fat, plus liquids should be given between rather than with meals, and milk contains some simple carbohydrates, which may not be tolerated.)

A good snack for a patient with dumping syndrome is a. cheese and whole grain crackers. b. applesauce and graham crackers. c. nonfat milk and pretzels. d. fig bars and juice.

Divide food into four to six meals a day (The volume of food in the stomach should be kept small to limit pressure on the lower esophageal sphincter. Snacking in the evening can cause reflux. The last meal should be eaten at least three hours before bedtime; individual bedtimes vary. Peppermint promotes reflux because it relaxes the lower esophageal sphincter, allowing food to be regurgitated into the esophagus.)

A healthcare provider prescribes dietary and medication therapy for a client with the diagnosis of gastroesophageal reflux disease (GERD). What is most appropriate for the nurse to teach the client about meal management? Snack daily in the evenings Divide food into four to six meals a day Eat the last of three daily meals by 8:00 PM Suck a peppermint candy after each meal

One hour before or 2 hours after famotidine (Antacids interfere with complete absorption of famotidine; therefore antacids should be administered at least 1 hour before or 2 hours after famotidine. Magnesium hydroxide/aluminum hydroxide usually is taken 1 hour after meals and at bedtime. Famotidine usually is prescribed once a day at bedtime. The client has received a prescription for both medications; the client should not be instructed to omit one of the medications without checking with the healthcare provider first.)

A healthcare provider prescribes famotidine and magnesium hydroxide/aluminum hydroxide antacid for a client with a peptic ulcer. The nurse should teach the client to take the antacid at what time? Only at bedtime, when famotidine is not taken Only if famotidine is ineffective At the same time as famotidine, with a full glass of water One hour before or 2 hours after famotidine

Impaired circulation due to medication. (The most immediate concern for a patient with priapism, a condition caused by lack of circulation to the penis, is that this can cause further health complications. Anxiety, sexual dysfunction, and ineffective coping are all also valid nursing diagnoses but are not a priority for this patient. The diagnosis that causes the most harm to the patient should be addressed first.)

A male patient with diabetes who is taking medication for erectile dysfunction is experiencing pain and discomfort related to the side effect of priapism. The nurse knows that this patient is at greatest risk for Sexual dysfunction related to low self-esteem. Impaired circulation due to medication. Anxiety related to erectile dysfunction. Ineffective coping related to chronic illness.

b. Ensure adequate staff when moving the client. (Many hospitals that see bariatric-sized clients have appropriate equipment for this population. A hospital that does not typically see these clients is less likely to have appropriate equipment, putting staff and client safety at risk. The nurse ensures enough staffing is available to help with all aspects of mobility. It may or may not be appropriate to assess the client's willingness to make lifestyle changes. Leaving the siderails down may present a safety hazard. The staff should be sensitive to this client's situation, but safety takes priority.)

A morbidly obese client is admitted to a community hospital that does not typically care for bariatric-sized clients. What action by the nurse is most appropriate? a. Assess the client's readiness to make lifestyle changes. b. Ensure adequate staff when moving the client. c. Leave siderails down to prevent pressure ulcers. d. Reinforce the need to be sensitive to the client.

c. Light-colored stools (Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic cholecystitis. The other symptoms are seen equally with both chronic and acute cholecystitis.)

A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy's sign c. Light-colored stools d. Upper abdominal pain after eating

b. Apply an ice pack to the site. (The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh-frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level of intervention. Changing the client's position will not decrease bleeding.)

A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client's right lower back. Which action should the nurse take? a. Administer fresh-frozen plasma. b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results.

a. "Do any of your family members have this problem?" (There is a strong association between family history and stone formation and recurrence. Nephrolithiasis is associated with many genetic variations; therefore, the nurse should ask whether other family members have also had renal stones. The other questions do not refer to renal calculi but instead are questions that should be asked of a client with a urinary tract infection.)

A nurse assesses a client who presents with renal calculi. Which question should the nurse ask? a. "Do any of your family members have this problem?" b. "Do you drink any cranberry juice?" c. "Do you urinate after sexual intercourse?" d. "Do you experience burning with urination?"

d. Ask the client if he or she has ever been evaluated for sleep apnea. (Clients are usually unaware that they have sleep apnea, but it should be suspected in people who have persistent daytime sleepiness and report waking up tired. Causes of the problem should be assessed before the client is offered suggestions for treatment.)

A nurse assesses a client who reports waking up feeling very tired, even after 8 hours of good sleep. Which action should the nurse take first? a. Contact the provider for a prescription for sleep medication. b. Tell the client not to drink beverages with caffeine before bed. c. Educate the client to sleep upright in a reclining chair. d. Ask the client if he or she has ever been evaluated for sleep apnea.

c. A 55-year-old woman who is 50 pounds overweight (The client at highest risk would be the one who is extremely overweight. None of the other clients have risk factors for sleep apnea.)

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for development of obstructive sleep apnea? a. A 26-year-old woman who is 8 months pregnant b. A 42-year-old man with gastroesophageal reflux disease c. A 55-year-old woman who is 50 pounds overweight d. A 73-year-old man with type 2 diabetes mellitus

c. Fill out and file a variance report. (The nurse should complete a variance report per agency policy. Asking another nurse to help and requesting better equipment are both good ideas, but the nurse may have an injury that needs care. It would be unethical to refuse to care for this client again.)

A nurse attempted to assist a morbidly obese client back to bed and had immediate pain in the lower back. What action by the nurse is most appropriate? a. Ask another nurse to help next time. b. Demand better equipment to use. c. Fill out and file a variance report. d. Refuse to assist the client again.

a. "Bile salts accumulate in the skin and cause the itching." (In obstructive jaundice, the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin. This leads to itching, or pruritus. The other statements are not accurate.)

A nurse cares for a client who has obstructive jaundice. The client asks, "Why is my skin so itchy?" How should the nurse respond? a. "Bile salts accumulate in the skin and cause the itching." b. "Toxins released from an inflamed gallbladder lead to itching." c. "Itching is caused by the release of calcium into the skin." d. "Itching is caused by a hypersensitivity reaction."

b. Administer intravenous fluids. (Dehydration caused by diarrhea can occur quickly in older clients with Salmonella food poisoning, so maintenance of fluid balance is a high priority. Monitoring vital signs and providing perineal care are important nursing actions but are of lower priority than fluid replacement. The nurse should teach the client about proper hand hygiene to prevent the spread of infection, and preparation of food and beverages to prevent contamination.)

A nurse cares for an older adult client who has Salmonella food poisoning. The client's vital signs are heart rate: 102 beats/min, blood pressure: 98/55 mm Hg, respiratory rate: 22 breaths/min, and oxygen saturation: 92%. Which action should the nurse complete first? a. Apply oxygen via nasal cannula. b. Administer intravenous fluids. c. Provide perineal care with a premedicated wipe. d. Teach proper food preparation to prevent contamination.

Nasal polyps Obesity (Structural abnormalities, such as a deviated septum, nasal polyps, certain jaw configurations, or enlarged tonsils predispose a client to obstructive apnea. Individuals with mixed apnea often have signs and symptoms of right-sided heart failure. Respiratory tract infections do not predispose a client to obstructive sleep apnea. Clients with obstructive apnea are often middle-age, obese men. Obesity itself does not predispose a client to obstructive sleep apnea.)

A nurse caring for a patient prior to surgery should recognize which of the following factors place a client at risk for obstructive sleep apnea? (Select all that apply.) Heart disease Respiratory tract infections Nasal polyps Obesity

decreased erectile ability. (Recreational drugs, alcohol, and smoking cause erectile dysfunction. They are not related to the other three problems.)

A nurse counsels a client who smokes cigarettes and uses alcohol daily that he should be aware that these substances have been known to cause decreased erectile ability. decreased sperm count. gynecomastia. increased ejaculatory ability.

"I should watch more television to reduce the stress." "I should contact a surgeon about bariatric surgery." (Stress is a major cause of obesity. Rather than watching television to reduce stress, physical activities such as playing outdoor games and regular exercise should be undertaken. Bariatric surgery is performed only when there is morbid obesity. Reducing the consumption of fat-rich foods and increasing the consumption of vegetables will help with weight reduction.)

A nurse educates an obese adolescent about healthy dietary habits and risks associated with obesity. Which statements by the adolescent indicate the need for further counseling? Select all that apply. "I should exercise regularly." "I should play more outdoor games." "I should watch more television to reduce the stress." "I should add lots of vegetables to my diet." "I should contact a surgeon about bariatric surgery."

Reinforce the dressing. (The nurse should anticipate drainage and reinforce the surgical dressing as needed. Changing a dressing at this time is unnecessary and increases the risk for infection. Montgomery ties are used when frequent dressing changes are anticipated; they are not appropriate at this time. An abdominal binder rarely is prescribed, and it will interfere with assessment of the dressing at this time.)

A nurse in the postanesthesia care unit (PACU) is providing care to a client who had an abdominal cholecystectomy and observes serosanguineous drainage on the abdominal dressing. What is the next nursing action? Change the dressing. Reinforce the dressing. Replace the tape with Montgomery ties. Support the incision with an abdominal binder.

Metronidazole (Flagyl) (The drugs of choice for treatment of giardiasis are metronidazole (Flagyl), tinidazole (Tindamax), and nitazoxanide (Alinia). These are classified as antifungals. Amoxicillin and clarithromycin are antibiotics that treat bacterial infections. Prednisone is a steroid and is used as an anti-inflammatory medication.)

A nurse is admitting a child to the hospital with a diagnosis of giardiasis. Which medication should the nurse expect to be prescribed? Metronidazole (Flagyl) Amoxicillin clavulanate (Augmentin) Clarithromycin (Biaxin) Prednisone (Orapred)

Permanent vascular damage (The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or erectile dysfunction.)

A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? Urinary tract infection Chronic pain Permanent vascular damage Future erectile dysfunction

Encouraging coughing and deep breathing (Because of the high abdominal surgical incision, clients often avoid deep breathing and coughing and therefore need support and encouragement to accomplish these actions. Although maintaining T-tube drainage is important, encouraging coughing and deep breathing supports effective gas exchange, which is essential to prevent serious respiratory complications. Ensuring a pain-free experience may not be possible; some discomfort is expected. The nursing goal is to keep the client's pain at least at a tolerable level. Providing a heating pad for shoulder pain for 15 minutes hourly is employed for the shoulder pain caused by retained carbon dioxide after a laparoscopic cholecystectomy, not for an abdominal cholecystectomy.)

A nurse is caring for a client who had an open abdominal cholecystectomy because of biliary colic. Which nursing action is most important during the postoperative period? Maintaining T-tube drainage Ensuring a pain-free experience Encouraging coughing and deep breathing Providing a heating pad for shoulder pain for 15 minutes hourly

c. "This medication will promote daytime wakefulness." (Modafinil is helpful for clients who have narcolepsy (uncontrollable daytime sleep) related to sleep apnea. This medication promotes daytime wakefulness.)

A nurse is caring for a client who has sleep apnea and is prescribed modafinil (Provigil). The client asks, "How will this medication help me?" How should the nurse respond? a. "This medication will treat your sleep apnea." b. "This sedative will help you to sleep at night." c. "This medication will promote daytime wakefulness." d. "This analgesic will increase comfort while you sleep."

Small, frequent feeding schedule (Small feedings reduce the amount of bulk passing into the jejunum and therefore reduce the fluid that shifts into the jejunum. Although a diet high in roughage may be avoided, a low-residue, bland diet is not necessary. Total fluid intake does not have to be restricted; however, fluids should not be taken immediately before, during, or after a meal because they promote rapid stomach emptying. Concentrated sweets pass rapidly out of the stomach and increase fluid shifts; the diet should be low in carbohydrates. Relatively high protein is needed to promote tissue repair.)

A nurse is caring for a client who is scheduled for a gastric bypass to treat morbid obesity. Which diet should the nurse teach the client to maintain because it will help minimize clinical manifestations of dumping syndrome? Low-residue, bland diet Fluid intake below 500 mL Small, frequent feeding schedule Low-protein, high-carbohydrate diet

Regular diet with foods that are tolerated (No specific diet is recommended; the client is encouraged to avoid meals that overdistend the stomach and foods that cause gastrointestinal (GI) distress. There is no need for a soft diet; a soft diet is appropriate for those who have difficulty with chewing and swallowing. The client does not require a liquid diet. High-fat dairy products increase GI secretions and may not be tolerated by some clients.)

A nurse is caring for a client who recently is diagnosed with a gastric ulcer. The nurse expects that the plan of care will include a prescription for which type of diet? Soft diet Low-fat, high-protein liquid diet Hourly feedings of dairy products Regular diet with foods that are tolerated

Low calcium (A low calcium intake is recommended. Calcium and phosphorus are components of these stones; foods high in calcium and phosphorus should be avoided. Low purine and high alkaline ash diets are indicated for clients with gout.)

A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information? Low purine Low calcium High phosphorus High alkaline ash

b. Ensuring siderails are not causing excess pressure (All actions are good for client comfort, but when dealing with an obese client, the staff should take extra precautions, such as ensuring the siderails are not putting pressure on the client's tissues. The other options are appropriate for any client, and are not specific to obese clients.)

A nurse is caring for a morbidly obese client. What comfort measure is most important for the nurse to delegate to the unlicensed assistive personnel (UAP)? a. Designating "quiet time" so the client can rest b. Ensuring siderails are not causing excess pressure c. Providing oral care before and after meals and snacks d. Relaying any reports of pain to the registered nurse

Potassium level (In elderly patients, it is important to monitor the patient's serum electrolyte levels closely. Diarrhea is less likely to cause an alteration in white blood cell, creatinine, and hemoglobin levels.)

A nurse is caring for an older adult who has been experiencing severe Clostridium difficile-related diarrhea. When reviewing the patient's most recent laboratory tests, the nurse should prioritize which of the following? White blood cell level Creatinine level Hemoglobin level Potassium level

b. Increase the amount of vegetables to 1.1 cups/1000 calories. d. Reduce the number of adults who are obese by 10%. e. Reduce the consumption of saturated fat by nearly 10%. (Some of the goals in this initiative include increasing fruit consumption to 0.9 cups/1000 calories, increasing vegetable intake to 1.1 cups/1000 calories, increasing the number of people at a healthy weight by 10%, decreasing the number of adults who are obese by 10%, and reducing the consumption of saturated fats by 9.5%.)

A nurse is designing a community education program to meet the Healthy People 2020 objectives for nutrition and weight status. What information about these goals does the nurse use to plan this event? (Select all that apply.) a. Decrease the amount of fruit to 1.1 cups/1000 calories. b. Increase the amount of vegetables to 1.1 cups/1000 calories. c. Increase the number of adults at a healthy weight by 25%. d. Reduce the number of adults who are obese by 10%. e. Reduce the consumption of saturated fat by nearly 10%.

b. The patient has referred pain sensations. The nurse should follow orders for administering pain medication. (Referred pain is a very real physical complaint, and the nurse should give the patient the pain medication as ordered.)

A nurse is notified when a patient, newly admitted with liver and gallbladder disease, complains of pain in the right middle back and asks for some pain medication. What is the best interpretation of this reported assessment by the nurse? a. The patient is just complaining to see whether the staff will give out pain medications. b. The patient has referred pain sensations. The nurse should follow orders for administering pain medication. c. The patient has an injury on the back from an unknown cause that needs immediate assessment. d. The patient is a chronic complainer with anxieties about his condition.

"I smoke one pack of cigarettes a day." (Smoking cigarettes increases the acidity of gastrointestinal secretions, which damages the mucosal lining. While blood type O is more frequently associated with duodenal ulcer, type A has no significance. Being overweight is unrelated to peptic ulcer disease. High blood pressure is not directly related to peptic ulcer disease.)

A nurse is obtaining a health history from a client with the diagnosis of peptic ulcer disease. Which client statement provides evidence to support the identification of a possible contributory factor? "My blood type is A positive." "I smoke one pack of cigarettes a day." "I have been overweight most of my life." "My blood pressure has been high lately."

Pain that is relieved with eating (Duodenal ulcer pain is relieved with food and antacids and often awakens the client at night when sleeping. Gastric ulcer pain is worse with eating or one hour after eating.)

A nurse is performing the initial history and physical examination of a client with a diagnosis of duodenal ulcer. Which type of pain does the nurse expect the client to describe? Pain that is relieved with eating Pain that is worse with antacids Pain that is relieved with sleep Pain that is worse one hour after eating

a. Administer the drug through a separate IV line. b. Infuse pantoprazole using an IV pump. e. Use an in-line IV filter when infusing. (When infusing pantoprazole, use a separate IV line, a pump, and an in-line filter. A brown wrapper and frequent vital signs are not needed.)

A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate? (Select all that apply.) a. Administer the drug through a separate IV line. b. Infuse pantoprazole using an IV pump. c. Keep the drug in its original brown bag. d. Take vital signs frequently during infusion. e. Use an in-line IV filter when infusing.

Avoid heavy lifting. Avoid drinking alcohol. Eat small, frequent meals. (Heavy lifting increases intraabdominal pressure, allowing gastric contents to move up through the lower esophageal sphincter (regurgitation), causing heartburn (pyrosis). Alcohol, in addition to peppermints, caffeine, and chocolate, decreases lower esophageal sphincter (LES) pressure, which permits gastric contents to move from the stomach into the esophagus. Eating small, frequent meals limits the amount of food in the stomach, which limits gastroesophageal reflux. Lying down after eating promotes reflux and should be avoided. Increasing fluids with meals increases gastric volume, causing distention and reflux. Constrictive garments, such as belts, binders, and girdles, increase intraabdominal pressure and may lead to reflux.)

A nurse is providing discharge instructions for a client with a diagnosis of gastroesophageal reflux disease (GERD). What should the nurse advise the client to do to limit symptoms of GERD? Select all that apply. Avoid heavy lifting. Lie down after eating. Avoid drinking alcohol. Eat small, frequent meals. Increase fluid intake with meals. Wear an abdominal binder or girdle.

a. Vasodilator for hypertension (Vasodilators taken for the control of hypertension frequently cause ED.)

A nurse is reviewing the drugs taken by a 50-year-old male patient. What medication should the nurse recognize as the most probable cause of erectile dysfunction (ED)? a. Vasodilator for hypertension b. Antibiotic for an upper respiratory infection c. Antihistamine for allergies d. Glucophage for type 2 diabetes

"I will place a 6-inch (15 cm) block under the head of my bed to help with digestion." (Elevation of the head of the bed can enhance esophageal emptying and reduce symptoms of GERD. A low-fat, high-protein diet is recommended. Eating should be avoided three hours before bedtime to reduce acid production, and the client should be instructed to consume small, frequent meals throughout the day to avoid gastric distention.)

A nurse is teaching a client about gastroesophageal reflux disease (GERD). Which statement made by the client indicates correct understanding of GERD management? "Three meals per day is the best regimen to avoid GERD symptoms." "I can reduce my GERD symptoms through a high-carbohydrate, low-fat diet." "A snack at bedtime will help reduce the acidity of my stomach during the night." "I will place a 6-inch (15 cm) block under the head of my bed to help with digestion."

c. "Report diarrhea to your provider." (Maalox can cause hypermagnesemia, which causes diarrhea, so the client should be taught to report this to the provider. Aspirin is avoided with bismuth sulfate (Pepto-Bismol). Black stools can be caused by Pepto-Bismol. Maalox should be taken after meals.)

A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate? a. "Aspirin must be avoided." b. "Do not worry about black stools." c. "Report diarrhea to your provider." d. "Take 1 hour before meals."

Rotavirus is more common among infants and younger children. Don't drink water when swimming to prevent E. coli infection. All clients with botulism require hospitalization. Parasitic diseases may not show up for 1 to 2 weeks after infection. (Rotavirus is more common among the youngest of clients, not drinking water while swimming can help prevent E. coli infection, people with botulism need to be hospitalized to monitor for respiratory failure and paralysis, and parasitic diseases may take up to 2 weeks to become symptomatic. The other statements are not accurate.)

A nurse is teaching a community group about food poisoning and gastroenteritis. Which statements by the nurse are accurate? (Select all that apply.) Rotavirus is more common among infants and younger children. Escherichia coli diarrhea is transmitted by contact with infected animals. Don't drink water when swimming to prevent E. coli infection. All clients with botulism require hospitalization. Parasitic diseases may not show up for 1 to 2 weeks after infection.

a. Chocolate c. Citrus fruits d. Peppermint e. Tomato sauce (Chocolate, citrus fruits such as oranges and grapefruit, peppermint and spearmint, and tomato-based products all contribute to the reflux associated with GERD. Caffeinated teas, coffee, and sodas should be avoided.)

A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.) a. Chocolate b. Decaffeinated coffee c. Citrus fruits d. Peppermint e. Tomato sauce

History of hyperparathyroidism (Hyperparathyroidism results in high serum calcium levels; as the blood is filtered through the nephron, precipitates of calcium may form calculi. Increased fluid intake will discourage stone formation by preventing stagnation of urine. A urine specific gravity of 1.017 is within the expected range of 1.010 to 1.030 and will not increase the risk of developing urinary calculi. A jogging schedule of 3 miles (4.8 km) daily reduces the risk of developing urinary calculi; activity improves glomerular filtration and inhibits calcium from leaving the bone.)

A nurse reviews the history of a client who is hospitalized with a diagnosis of urinary calculi and identifies that which factor may have contributed to the development of the calculi? Increased fluid intake Urine specific gravity of 1.017 Jogging 3 miles (4.8 km) a day History of hyperparathyroidism

a. "Finish the prescribed antibiotic even if you are feeling better." b. "Drink at least 3 liters of fluid each day." c. "The bruising on your back may take several weeks to resolve." (The client should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The client should drink at least 3 liters of fluid daily to dilute potential stone-forming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the client should expect bruising that may take several weeks to resolve. The client should also experience blood in the urine for several days. The client should report any pain, fever, chills, or difficulty with urination to the provider as these may signal the beginning of an infection or the formation of another stone.)

A nurse teaches a client about self-care after experiencing a urinary calculus treated by lithotripsy. Which statements should the nurse include in this client's discharge teaching? (Select all that apply.) a. "Finish the prescribed antibiotic even if you are feeling better." b. "Drink at least 3 liters of fluid each day." c. "The bruising on your back may take several weeks to resolve." d. "Report any blood present in your urine." e. "It is normal to experience pain and difficulty urinating."

a. "Wash leafy vegetables carefully before eating or cooking them." c. "Wash your hands before and after using the bathroom." d. "Be sure meat is cooked to the proper temperature." e. "Avoid eating eggs that are sunny side up or undercooked." f. "When eating outdoors, be sure to keep flies off your food." (Salmonella is usually contracted via contaminated eggs, beef, poultry, and green leafy vegetables. It is not transmitted through water in garden hoses or pools. Clients should wash leafy vegetables well, wash hands before and after using the restroom, make sure meat and eggs are cooked properly, and, because it can be transmitted by flies, keep flies off of food.)

A nurse teaches a client how to avoid becoming ill with Salmonella infection again. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Wash leafy vegetables carefully before eating or cooking them." b. "Do not ingest water from the garden hose or the pool." c. "Wash your hands before and after using the bathroom." d. "Be sure meat is cooked to the proper temperature." e. "Avoid eating eggs that are sunny side up or undercooked." f. "When eating outdoors, be sure to keep flies off your food."

a. "Drink plenty of fluids to prevent dehydration." (The client should drink plenty of fluids to prevent dehydration. Milk products may not be tolerated. Caffeinated beverages increase intestinal motility and should be avoided.)

A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this client's teaching? a. "Drink plenty of fluids to prevent dehydration." b. "You should only drink 1 liter of fluids daily." c. "Increase your protein intake by drinking more milk." d. "Sips of cola or tea may help to relieve your nausea."

Baked chicken Roast beef with mashed potato (Baked chicken is relatively low in calcium. Roast beef and mashed potato have moderate amounts of calcium. Pudding is made with milk and is high in calcium. Cheese is high in calcium. Ice cream is made with milk and is high in calcium.)

A nurse teaches a client with calcium-based renal calculi about foods that can be eaten on a low-calcium diet. The nurse concludes that the teaching is effective when the client selects which food items from the menu? Select all that apply. Baked chicken Chocolate pudding Salmon loaf with cheese sauce Roast beef with mashed potato Vanilla ice cream with chocolate syrup

a. "Rotavirus is more common among infants and younger children." c. "To prevent E. coli infection, don't drink water when swimming." e. "Parasitic diseases may not show up for 1 to 2 weeks after infection." (Rotavirus is more common among the youngest of clients. Not drinking water while swimming can help prevent E. coli infection. Parasitic diseases may take up to 2 weeks to become symptomatic. People with botulism need to be hospitalized to monitor for respiratory failure and paralysis. Escherichia coli is not transmitted by contact with infected animals.)

A nurse teaches a community group about food poisoning and gastroenteritis. Which statements should the nurse include in this group's teaching? (Select all that apply.) a. "Rotavirus is more common among infants and younger children." b. "Escherichia coli diarrhea is transmitted by contact with infected animals." c. "To prevent E. coli infection, don't drink water when swimming." d. "Clients who have botulism should be quarantined within their home." e. "Parasitic diseases may not show up for 1 to 2 weeks after infection."

a. "Use a second form of birth control while on this medication." (The client should use a second form of birth control because penicillin seems to reduce the effectiveness of estrogen-containing contraceptives. She should not experience increased menstrual bleeding, an irregular heartbeat, or blood in her urine while taking the medication.)

A nurse teaches a young female client who is prescribed amoxicillin (Amoxil) for a urinary tract infection. Which statement should the nurse include in this client's teaching? a. "Use a second form of birth control while on this medication." b. "You will experience increased menstrual bleeding while on this drug." c. "You may experience an irregular heartbeat while on this drug." d. "Watch for blood in your urine while taking this medication."

Contact (Contact precautions are used for organisms that are spread by skin-to-skin contact, such as antibiotic-resistant organisms or Clostridium difficile. Droplet precautions are used for organisms that can be transmitted by close, face-to-face contact, such as influenza or meningococcal meningitis. Airborne precautions are required for patients with presumed or proven pulmonary TB or chickenpox. Positive pressure isolation is unnecessary and ineffective.)

A nursing home patient has been diagnosed with Clostridium difficile. What type of precautions should the nurse implement to prevent the spread of this infectious disease to other residents? Contact Droplet Airborne Positive pressure isolation

Dysrhythmias Hypotension Delirium (The patient is assessed for signs and symptoms of fluid and electrolyte imbalances, including lethargy, rapid pulse rate, fever, oliguria, anuria, hypotension, and delirium. Hyperglycemia and hypothermia are not typically associated with fluid and electrolyte imbalances.)

A patient admitted to the ED with severe diarrhea and vomiting is subsequently diagnosed with food poisoning. The nurse caring for this patient assesses for signs and symptoms of fluid and electrolyte imbalances. For what signs and symptoms would this nurse assess? Select all that apply. Dysrhythmias Hypothermia Hypotension Hyperglycemia Delirium

Ureter (Ureteral pain is characterized as a dull continuous pain that may be intense with voiding. The pain may be described as sharp or stabbing if the bladder is full. This type of pain is inconsistent with a stone being present in the bladder. Stones are not normally situated in the urethra or meatus.)

A patient admitted to the medical unit with impaired renal function is complaining of severe, stabbing pain in the flank and lower abdomen. The patient is being assessed for renal calculi. The nurse recognizes that the stone is most likely in what anatomic location? Meatus Bladder Ureter Urethra

Using sitz baths three times daily (An important comfort measure for a patient admitted with severe diarrhea experiencing skin breakdown is using sitz baths three times daily.Barrier creams, not hydrocortisone creams, may be used. The skin would be cleaned gently with soap and warm, not hot, water. Absorbent cotton underwear helps keep the skin dry but is not a comfort measure.)

A patient admitted with severe diarrhea is experiencing skin breakdown from frequent stools. What is an important comfort measure for this patient? Applying hydrocortisone cream Cleaning the area with soap and hot water Using sitz baths three times daily Wearing absorbent cotton underwear

Loperamide (Imodium) (The nurse expects the primary health care provider to prescribe loperamide for a patient with severe gastroenteritis who still has excessive diarrhea. If the primary health care provider determines that antiperistaltic agents are necessary, an initial dose of loperamide (Imodium) 4 mg can be administered orally, followed by 2 mg after each loose stool, up to 16 mg daily.Balsalazide is not the best choice for control of diarrhea in this scenario. Mesalamine is used for patients with ulcerative colitis for long-term therapy. MOM is a laxative.)

A patient admitted with severe gastroenteritis has been started on an IV, but the patient continues having excessive diarrhea. Which medication does the nurse expect the primary health care provider to prescribe? Balsalazide (Colazal) Loperamide (Imodium) Mesalamine (Asacol) Milk of Magnesia (MOM)

sildenafil (Viagra), an erectile dysfunction medication (Drugs that interact with alpha blockers such as tamsulosin include erectile dysfunction drugs; additive hypotensive effects may occur. The other drugs do not interact with tamsulosin.)

A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic hyperplasia. The nurse is checking his current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug? levothyroxine (Synthroid) for hypothyroidism sildenafil (Viagra), an erectile dysfunction medication omeprazole (Prilosec), a proton pump inhibitor low-dose aspirin for stroke prevention

"Avoid caffeine-containing foods and beverages." (The nurse tells the patient to avoid caffeine-containing foods and beverages. The nurse also teaches the patient to limit or eliminate foods that decrease lower esophageal sphincter (LES) pressure and that irritate inflamed tissue, causing heartburn. These foods include peppermint, chocolate, alcohol, fatty foods (especially fried), caffeine, and carbonated beverages.The nurse also needs to remind the patient to eat four to six small meals each day rather than three large ones and avoid snacking between meals. Large meals increase the volume of and pressure in the stomach and delay gastric emptying. Peppermint decreases LES pressure and increases the risk of symptoms. Patients need to be taught to elevate the head by 6 to 12 inches (30 cm) for sleep to prevent nighttime reflux.)

A patient has been diagnosed with mild gastroesophageal reflux disease (GERD) and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this patient? "Avoid caffeine-containing foods and beverages." "Eat three meals each day and avoid snacking between meals." "Peppermint lozenges help to reduce stomach upset." "Sleep on your left side with a pillow between your knees."

Ingestion of parasites in the water (The likely cause of gastroenteritis when a patient travels outside the country is ingestion of water that is infested with parasites.Bacteria on the patient's hands will not produce gastroenteritis unless food or water is contaminated with the bacteria. Insufficient vaccinations may cause other disease processes, but not gastroenteritis. Undercooked, not overcooked, food may produce gastroenteritis.)

A patient has developed gastroenteritis while traveling outside the country. What is the likely cause of the patient's symptoms? Bacteria on the patient's hands Ingestion of parasites in the water Insufficient vaccinations Overcooked food

a. Prevent stress ulcers (Stress-related mucosal damage is an important issue for critically ill patients. Stress ulcer prophylaxis (or therapy to prevent severe gastrointestinal [GI] damage) is undertaken in almost every critically ill patient in an intensive care unit and for many patients on general medical surgical units. Procedures performed commonly in critically ill patients, such as passing nasogastric tubes, placing patients on ventilators, and others, predispose patients to bleeding of the GI tract. Guidelines suggest that all such patients receive either a histamine receptor-blocking drug or a proton pump inhibitor. The other options are incorrect.)

A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect? a. Prevent stress ulcers b. Reduce bacteria levels in the stomach c. Reduce gastric gas formation (flatulence) d. Promote gastric motility

Ask the patient about oral intake, current medications and description of episodes. (The nurse's first action would be further assessment of the patient's risk factors for gastroesophageal reflux disease (GERD). Before suggesting interventions or beginning patient teaching, the nurse must elicit more information about the patient's symptoms.The nurse needs additional data before telling the patient about antacid effects, sleeping with the head elevated, or not drinking alcohol late in the evening.)

A patient in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? Teach the patient about antacid effects and side effects. Ask the patient about oral intake, current medications and description of episodes. Suggest that the patient sleep with the head elevated 6 inches (15 cm). Tell the patient to avoid drinking alcohol late in the evening.

"You may have consumed contaminated food or water." (When a patient with severe viral gastroenteritis caused by norovirus asks, "How did I get this disease?", the nurse answers, "You may have consumed contaminated food or water." Norovirus is the leading foodborne disease that causes gastroenteritis. It is transmitted via the fecal-oral route from person to person and from contaminated food and water. Vomiting causes the virus to become airborne.Campylobacter, not novovirus, can be transmitted by contact with infected infants or animals. Escherichia coli, not novovirus, may be spread via animals and contaminated food, water, or fomites. HIV, not novovirus, may be spread via the blood. Campylobacter and E. coli both cause bacterial gastroenteritis, while norovirus causes viral gastroenteritis.)

A patient is admitted with severe viral gastroenteritis caused by norovirus. The patient asks the nurse, "How did I get this disease?" Which answer by the nurse is correct? "You may have contracted it from an infected infant." "You may have consumed contaminated food or water." "You may have come into contact with an infected animal." "You may have had contact with the blood of an infected person."

a. Their use may result in kidney stones. (Calcium antacids are not used as frequently as other antacids because their use may lead to the development of kidney stones; they also cause increased gastric acid production. The other options are incorrect.)

A patient is asking advice about which over-the-counter antacid is considered the most safe to use for heartburn. The nurse explains that the reason that calcium antacids are not used as frequently as other antacids is for which of these reasons? a. Their use may result in kidney stones. b. They cause decreased gastric acid production. c. They cause severe diarrhea. d. Their use may result in fluid retention and edema.

Starting a large-bore IV (The nursing intervention that has the highest priority for a patient with a bleeding peptic ulcer is to start a large-bore IV. A large-bore IV is inserted so that blood products can be administered.IV pain medication is not a recommended treatment for gastrointestinal bleeding. Intubation is also not recommended. The mental status of the patient would be monitored, but it is not necessary to monitor the anxiety level of the patient.)

A patient is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? Starting a large-bore IV Administering IV pain medication Preparing equipment for intubation Monitoring the patient's anxiety level

b. Constipation (Aluminum-based antacids have a constipating effect as well as an acid-neutralizing capacity. The other options are incorrect.)

A patient is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect? a. Diarrhea b. Constipation c. Nausea d. Abdominal cramping

"The entire capsule must be taken whole, not crushed, chewed, or opened." (Omeprazole needs to be taken before meals, and an entire capsule must be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD. This medication is used on a long-term basis to maintain healing.)

A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). The nurse will include which statement in the teaching plan about this medication? "Take this medication once a day after breakfast." "You will be on this medication for only 2 weeks for treatment of the reflux disease." "The medication may be dissolved in a liquid for better absorption." "The entire capsule must be taken whole, not crushed, chewed, or opened."

d. "The entire capsule must be taken whole, not crushed, chewed, or opened." (Omeprazole needs to be taken before meals, and an entire capsule must be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD. This medication is used on a long-term basis to maintain healing.)

A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). The nurse will include which statement in the teaching plan about this medication? a. "Take this medication once a day after breakfast." b. "You will be on this medication for only 2 weeks for treatment of the reflux disease." c. "The medication may be dissolved in a liquid for better absorption." d. "The entire capsule must be taken whole, not crushed, chewed, or opened."

a. Hypertonic fluid entering the jejunum and pulling large amounts of water from the circulating volume (Enteral tube feedings can cause dumping syndrome by pooling feeding in the jejunum, which pulls fluid from the circulating volume and causes hypotension.)

A patient on an enteral feeding suddenly complains of feeling faint and is sweating. The diastolic blood pressure has dropped 20 points. The nurse recognizes this as signs of the dumping syndrome. What is the cause of dumping syndrome? a. Hypertonic fluid entering the jejunum and pulling large amounts of water from the circulating volume b. Rich enteral feeding causing bowel irritation with severe cramping c. Hypertonic solution rapidly entering the stomach causing pyloric spasm d. Rapid drop in blood glucose as a result of the hypertonic solution pooling in the jejunum

"Consume extra fluids to replace fluid losses." (The nurse tells the patient to drink extra fluids to replace fluid lost through vomiting and diarrhea.It is not necessary to stop all solid food intake. Antidiarrheal medications are used if diarrhea is severe. Antibiotics are used if the infection is bacterial.)

A patient who developed viral gastroenteritis with vomiting and diarrhea is scheduled to be seen in the clinic the following day. What will the nurse teach the patient to do in the meantime? "Avoid all solid foods to allow complete bowel rest." "Consume extra fluids to replace fluid losses." "Take an over-the-counter antidiarrheal medication." "Contact your primary health care provider for an antibiotic medication."

Rigidity of the abdomen (The location of the subcostal incision will likely cause the patient to take shallow breaths to prevent pain, which may result in decreased breath sounds. The nurse should remind patients to take deep breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery; analgesics should be administered for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to drain from the drainage tract after surgery, which will require frequent changes of the abdominal dressing. Increased abdominal tenderness and rigidity should be reported immediately to the physician, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure.)

A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment finding to the physician? Decreased breath sounds Drainage of bile-colored fluid onto the abdominal dressing Rigidity of the abdomen Acute pain with movement

b. Slowing the rate of infusion (The most common cause of diarrhea during a feeding is dumping syndrome as a result of rapid feed infusion. Slowing the feeding is the appropriate initial action. Antidiarrheal medications are not indicated unless slowing the infusion fails. Total parenteral nutrition is not indicated for patients with a functioning gastrointestinal tract. Thickening the solution will increase the solute load and increase the risk for diarrhea.)

A patient who has been receiving continuous enteral nutrition has had several large, watery stools. The nurse will contact the provider to discuss which intervention? a. Administering antidiarrheal medications b. Slowing the rate of infusion c. Starting total parenteral nutrition d. Thickening the nutrition solution

b. He smokes two packs of cigarettes a day. (Smoking may impair the absorption of H₂ antagonists. The other factors are correct interventions for this medication.)

A patient who has been taking cimetidine (Tagamet) for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes that which factor may be influencing the effectiveness of this drug? a. He takes the cimetidine with meals. b. He smokes two packs of cigarettes a day. c. He drinks a glass of water with each dose. d. He takes an antacid 3 hours after the cimetidine dose.

Remind the patient that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. (Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.)

A patient who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the patient? Remind the patient that renal calculi have a noninfectious etiology and that a fever is unrelated to their recurrence. Remind the patient that occasional febrile episodes are expected following ESWL. Tell the patient to report to the ED for further assessment. Tell the patient to monitor his temperature for the next 24 hours and then contact his urologist's office.

metoclopramide (Reglan) (The use of metoclopramide (Reglan) is contraindicated in patients with a hypersensitivity to procaine or procainamide. There are no known interactions with the drugs listed in the other options.)

A patient who has severe nausea and vomiting following a case of food poisoning comes to the urgent care center. When reviewing his medication history, the nurse notes that he has an allergy to procaine. The nurse would question an order for which antiemetic drug if ordered for this patient? metoclopramide (Reglan) promethazine (Phenergan) phosphorated carbohydrate solution (Emetrol) palonosetron (Aloxi)

Increased serum calcium (Urinary stasis and an increased serum calcium level promote the formation of renal calculi.)

A patient who is immobile complains of severe pain in the right flank. The physician diagnoses the patient with renal calculi. This condition often results from Increased serum calcium Decreased serum calcium Increased serum phosphorous Decreased serum phosphorous

a. Avoiding hot, spicy foods b. Avoiding tobacco products e. Taking ibuprofen with food (Hot, spicy foods aggravate gastric upset, tobacco increases gastric secretions, and ibuprofen on an empty stomach increases gastric secretions, so patients should be taught to avoid these actions. Alcohol should be avoided since it increases gastric secretions. Eating at bedtime increases reflux, as does laying relatively flat to sleep, or wearing fitted clothing.)

A patient who recently began having mild symptoms of GERD is reluctant to take medication. What measures will the nurse recommend to minimize this patient's symptoms? (Select all that apply.) a. Avoiding hot, spicy foods b. Avoiding tobacco products c. Drinking a glass of red wine with dinner d. Eating a snack before bedtime e. Taking ibuprofen with food f. Using a small pillow for sleeping g. Wearing well-fitted clothing

d. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects. (Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other options are incorrect.)

A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some "embarrassing" adverse effects. She tells the nurse that she has had episodes of "not being able to control my bowel movements." Which statement is true about this situation? a. These are expected adverse effects that will eventually diminish. b. The patient will need to stop this drug immediately if these adverse effects are occurring. c. The patient will need to increase her fat intake to prevent these adverse effects. d. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.

c. 30 minutes to 4 hours before sexual activity. (Sildenafil should be taken at least 30 minutes and less than 4 hours prior to sexual activity. It is not taken daily or twice daily. If taken just prior to sexual activity, it does not have time to take effect.)

A patient will begin using sildenafil citrate (Viagra) to treat erectile dysfunction. The nurse will instruct the patient to take the medication a. daily in the morning. b. just prior to sexual activity. c. 30 minutes to 4 hours before sexual activity. d. twice daily.

Metoclopramide (Reglan) (Metoclopramide (Reglan) is useful in promoting gastric motility. Omeprazole and lansoprozole are proton pump inhibitors that reduce gastric acid secretion. Famotidine (Pepcid) is an H₂ receptor antagonist, which has a similar effect.)

A patient with GERD has undergone diagnostic testing and it has been determined that increasing the pace of gastric emptying may help alleviate symptoms. The nurse should anticipate that the patient may be prescribed what drug? Metoclopramide (Reglan) Omeprazole (Prilosec) Lansoprazole (Prevacid) Famotidine (Pepcid)

b. "This drug has been prescribed to help move food along through your GI tract." (Metoclopramide increases stomach and small intestine contractions (peristalsis), helping to move food through the GI system. Moving food quickly into the intestinal system decreases the likelihood of backup into the esophagus.)

A patient with gastroesophageal reflux disease (GERD) asks the nurse why metoclopramide (Reglan) has been prescribed. What is the nurse's best response? a. "This purpose of this drug for GERD is to prevent nausea." b. "This drug has been prescribed to help move food along through your GI tract." c. "Metoclopramide will prevent vomiting and the risk for aspiration." d. "This drug causes growth of new cells to heal your esophagus."

"Remain on a soft diet for about a week and avoid raw vegetables that are difficult to swallow." (After LNF, patients need to be taught to remain on a soft diet for 1 week and to avoid raw vegetables that are difficult to swallow.Carbonated beverages should be avoided. Patients may walk but need to avoid heavy lifting. Antireflux medications need to be taken for 1 month after the procedure.)

A patient with gastroesophageal reflux disease has undergone a laparoscopic Nissen fundoplication (LNF). What will the nurse include in postoperative home care instructions? "Consume carbonated beverages if you experience stomach upset." "Remain on a soft diet for about a week and avoid raw vegetables that are difficult to swallow." "You may resume running and weight lifting if you wish." "You may stop taking your antireflux medications after 1 week."

c. "I will take the ranitidine first thing in the morning so that its effect will last all day and night." (To prolong the effects of histamine H₂ blockers like ranitidine, they should be taken with meals. If a patient takes this drug once a day, giving it at bedtime prolongs the effects when there is no food in the stomach and reflux may be worse.)

A patient with gastroesophageal reflux disease is prescribed ranitidine (Zantac). Which statement by the patient indicates to the nurse a need for additional teaching? a. "If I need to use ranitidine for more than 2 weeks, I will notify my prescriber." b. "I will look into a smoking cessation program when I go home." c. "I will take the ranitidine first thing in the morning so that its effect will last all day and night." d. "I will not drive until I know how the ranitidine affects me."

"These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen." (The nurse's best response is that although licorice and slippery elm may be helpful in managing PUD, the patient must consult his or her primary health care provider before making a change in the treatment regimen.Alternative therapies may or may not be helpful in managing PUD. The patient must not use over-the-counter medications without first discussing it with his or her primary health care provider.)

A patient with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? "No, they probably won't be useful. You should use only prescription medications in your treatment plan." "These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen." "Yes, these are known to be effective in managing this disease but make sure you research the herbs thoroughly before taking them." "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

Remind the patient to take the CPAP device to the hospital. (The patient should be told to take the CPAP device to the hospital if an overnight stay is expected. Many patients will be able to use their own CPAP equipment, but hospital policy should be checked to make sure it can be used. Patients should be treated for pain and monitored for respiratory depression. Another PSG is not required before surgery. There is no need to call the hospital if the patient takes the CPAP device to the hospital.)

A patient with sleep apnea who uses a continuous positive airway pressure (CPAP) device is preparing to have inpatient surgery. Which instructions should the nurse provide to the patient? Remind the patient to take the CPAP device to the hospital. Plan to schedule a nighttime polysomnography (PSG) study before surgery. Discourage the patient from requesting pain medication while hospitalized. Call the hospital to ensure that mechanical ventilation will be available for the patient.

d. It is caused by a long-term antibiotic therapy. (Superinfections such as Clostridium difficile infections are caused by long-term antibiotic therapy, which kills all the natural flora of the bowel and causes diarrhea.)

A patient with the diagnosis of Clostridium difficile infection asks what has caused the diarrhea. What is the best response by the nurse? a. It is caused by a protozoal infection. b. It is caused by a fecal-oral contamination. c. It is caused by an inflammatory response. d. It is caused by a long-term antibiotic therapy.

Intolerance to foods high in fat Pain that radiates to the right shoulder (Interference with bile flow into the intestine will lead to an increasing inability to tolerate fatty foods. Although the gallbladder is in the upper right quadrant of the abdomen, when inflamed it can radiate to the right shoulder or scapula. Diarrhea with melena (black feces) is not associated with cholecystitis. Melena is tarry stools associated with upper gastrointestinal bleeding; diarrhea is associated with increased intestinal motility. Coffee-ground emesis is indicative of gastric bleeding; it is not associated with cholecystitis. Gnawing pain when the stomach is empty is associated with duodenal ulcers, not with cholecystitis.)

A primary healthcare provider diagnoses a client with acute cholecystitis with biliary colic. Which clinical findings should the nurse expect when performing a health history and physical assessment? Select all that apply. Diarrhea with black feces Intolerance to foods high in fat Vomiting of coffee-ground emesis Gnawing pain when stomach is empty Pain that radiates to the right shoulder

Explaining that fatty foods may not be tolerated for several weeks (Bile, which aids in fat digestion, is not as concentrated as before surgery. Once the body adapts to the absence of the gallbladder, the client should be able to tolerate a regular diet that contains fat. Initially the client should avoid fatty foods unless otherwise indicated. A low-protein diet is not necessary. Although teaching the client about a low-calorie diet to promote weight reduction is important, it is not as important as temporary avoidance of fatty foods with the gradual resumption of a regular diet. While vitamin C, vitamin A, and zinc are important, they are not the priority.)

A slightly overweight client is to be discharged from the hospital after a cholecystectomy. What is most important for the nurse to include in teaching the client about nutrition? Listing low-protein foods that may be included in the diet Explaining that fatty foods may not be tolerated for several weeks Teaching the importance of a low-calorie diet to promote weight reduction Encouraging the intake of high vitamin C, vitamin A, and zinc foods at each meal

Lower esophageal sphincter (The lower esophageal sphincter, also called the gastroesophageal sphincter or cardiac sphincter, is located at the junction of the esophagus and the stomach. An incompetent lower esophageal sphincter allows reflux (backward flow) of gastric contents. The upper esophageal sphincter and the hypopharyngeal sphincter are synonymous and are not responsible for the manifestations of GERD. The pyloric sphincter exists between the stomach and the duodenum.)

A staff educator is reviewing the causes of gastroesophageal reflux disease (GERD) with new staff nurses. What area of the GI tract should the educator identify as the cause of reduced pressure associated with GERD? Pyloric sphincter Lower esophageal sphincter Hypopharyngeal sphincter Upper esophageal sphincter

Obtains a 24-hour recall (diary) of his food intake (The most effective way to plan nutritional care for a client is to obtain a 24-hour recall of food intake. This will determine the client's food preferences and eating patterns so that they can be incorporated into the diet.Although calculating a BMI and measuring height and weight are important parts of a nutritional assessment, they do not address the issue of the client's food preferences. Keeping an activity diary will also not reveal any information related to the client's food preferences.)

A young adult man says that he cannot stay on a diet because of trouble finding one that will incorporate his food preferences. How does the nurse most effectively plan nutritional care for this client? Calculates his body mass index (BMI) Records a 24-hour diary of his physical activities Obtains a 24-hour recall (diary) of his food intake Measures his accurate height and weight measurements

Gown Gloves (Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in contact precautions only when spraying or splashing is anticipated. Shoe covers are not recommended in the CDC guidelines.)

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile? (select all that apply)? Mask Gown Gloves Shoe covers Eye protection

An administration route is not specified. (It is necessary to clarify the route of administration because ranitidine can be given by mouth, intravenously, or intramuscularly; the health care provider's prescription is incomplete. Ranitidine usually is given with meals. Ranitidine is used to decrease gastric acid and is helpful for clients with a peptic ulcer. 150 mg twice a day is the usual dose of ranitidine when given twice a day.)

After an acute episode of gastrointestinal (GI) bleeding, a client is diagnosed with a gastric ulcer. The client receives a prescription for ranitidine 150 mg twice a day. What concern prompts the nurse to contact the health care provider about the prescription? Ranitidine can increase bleeding risk. An administration route is not specified. Ranitidine is contraindicated for gastric ulcers. The recommended dose is higher than prescribed.

"Tell me what types of resources you think you might use after this surgery." (This statement allows the nurse to assess the individual patient's potential needs and preferences. The other statements offer the patient more information about the benefits of support groups, but fail to acknowledge the patient's preferences.)

After bariatric surgery, a patient who is being discharged tells the nurse, "I prefer to be independent. I am not interested in any support groups." Which response by the nurse is best? "I hope you change your mind so that I can suggest a group for you." "Tell me what types of resources you think you might use after this surgery." "Support groups have been found to lead to more successful weight loss after surgery." "Because there are many lifestyle changes after surgery, we recommend support groups."

b. Dumping syndrome (Dumping syndrome is caused by infusing a tube feeding too fast or infusing a tube feeding that is too rich a formula.)

After receiving a tube feeding, a nurse assesses the patient to be sweaty with abdominal distention and diarrhea. What is the most likely cause of this response? a. Expected reaction to the tube feeding b. Dumping syndrome c. Gastric reflux syndrome d. Onset of gastroenteritis

Place the patient on contact precautions. (The patient's history and new onset diarrhea suggest a C. difficile infection, which requires implementation of contact precautions to prevent spread of the infection to other patients. The other actions are also appropriate but can be accomplished after contact precautions are implemented.)

After several days of antibiotic therapy, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first? Notify the health care provider. Obtain a stool specimen for analysis. Teach the patient about handwashing. Place the patient on contact precautions.

ask the patient whether there have been any changes in exercise or diet patterns. (The initial nursing action should be assessment of any reason for the change in weight loss. The other actions may be needed, but further assessment is required before any interventions are planned or implemented.)

After successfully losing 1 lb weekly for several months, a patient at the clinic has not lost any weight for the last month. The nurse should first review the diet and exercise guidelines with the patient. instruct the patient to weigh and record weights weekly. ask the patient whether there have been any changes in exercise or diet patterns. discuss the possibility that the patient has reached a temporary weight loss plateau.

b. "I'll take the ciprofloxacin until the diarrhea has resolved." (Ciprofloxacin should be taken for 10 to 14 days to treat Salmonella infection, and should not be stopped once the diarrhea has cleared. Clients should be advised to take the entire course of medication. People with Salmonella should not prepare foods for others because the infection may be spread in this way. Hands should be washed with antibacterial soap before and after eating to prevent spread of the bacteria. Dishes and eating utensils should not be shared and should be cleaned thoroughly. Clients can be carriers for up to 1 year.)

After teaching a client who was hospitalized for Salmonella food poisoning, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "I will let my husband do all of the cooking for my family." b. "I'll take the ciprofloxacin until the diarrhea has resolved." c. "I should wash my hands with antibacterial soap before each meal." d. "I must place my dishes into the dishwasher after each meal."

a. "I should drink at least 3 liters of fluid every day." (Dehydration contributes to the precipitation of minerals to form a stone. Although increased intake of calcium causes hypercalcemia and leads to excessive calcium filtered into the urine, if the client is well hydrated the calcium will be excreted without issues. Dehydration increases the risk for supersaturation of calcium in the urine, which contributes to stone formation. The nurse should encourage the client to drink more fluids, not decrease calcium intake. Ingestion of aspirin or aspirin-containing products does not cause a stone. Antibiotics neither prevent nor treat a stone.)

After teaching a client with a history of renal calculi, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching? a. "I should drink at least 3 liters of fluid every day." b. "I will eliminate all dairy or sources of calcium from my diet." c. "Aspirin and aspirin-containing products can lead to stones." d. "The doctor can give me antibiotics at the first sign of a stone."

b. "I must take a shower or bathe every day." c. "I should have my well water tested." d. "I will ask my sexual partner to have a stool test." (Parasitic infections can be transmitted to other people. The client himself or herself should keep the toilet area clean instead of possibly exposing another person to the disease. Parasites are transmitted via unclean water sources and sexual practices with rectal contact. The client should test his or her well water and ask sexual partners to have their stool examined for parasites. Raw vegetables are not associated with parasitic gastrointestinal infections. The client can eat vegetables from the store or a home garden as long as the water source is clean.)

After teaching a client with a parasitic gastrointestinal infection, a nurse assesses the client's understanding. Which statements made by the client indicate that the client correctly understands the teaching? (Select all that apply.) a. "I'll have my housekeeper keep my toilet clean." b. "I must take a shower or bathe every day." c. "I should have my well water tested." d. "I will ask my sexual partner to have a stool test." e. "I must only eat raw vegetables from my own garden."

b. "I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel." (Toilet paper can irritate the sensitive perineal skin, so warm water rinses or soft cotton washcloths should be used instead. Although aloe vera may facilitate healing of superficial abrasions, it is not an effective skin barrier for diarrhea. Skin barriers such as zinc oxide and vitamin A and D ointment help protect the rectal area from the excoriating effects of liquid stools. Patting the skin is recommended instead of rubbing the skin dry.)

After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? a. "I'll rinse my rectal area with warm water after each stool and apply zinc oxide ointment." b. "I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel." c. "I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry." d. "I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment."

Hypertension Angina attacks Cardiac dysrhythmias Cerebral vascular accidents (Obstructive apnea causes a serious decline in arterial oxygen saturation level. Clients are at risk for cardiac dysrhythmias, right-sided heart failure, pulmonary hypertension, angina attacks, stroke, and hypertension. The other options are not directly related to a diminished supply of arterial oxygen.)

Although the most common effect of obstructive sleep apnea is a disrupted sleep pattern, the condition can cause a serious decline in arterial oxygen levels that may result in: (Select all that apply.) Hypertension Angina attacks Alzheimer's disease Cardiac dysrhythmias Cerebral vascular accidents Type 2 diabetes

Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr. (The request the nurse implements first is to start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr. Although the dextrose 5% in 0.45% sodium chloride is hypertonic in the IV bag, once it is infused, the glucose is rapidly metabolized and the fluid is really hypotonic. Fluid therapy is the focus of treatment for patients with gastroenteritis. Older patients are at increased risk for the complications of dehydration such as hypovolemia and acute kidney failure.Acetaminophen 650 mg should be administered rectally soon, and blood draws and stool specimen collection would also be implemented soon, but prevention and treatment of dehydration are the priorities for this patient.)

An 80-year-old patient with a 2-day history of myalgia, nausea, vomiting, and diarrhea is admitted to the medical-surgical unit with a diagnosis of gastroenteritis. Which primary health care provider request does the nurse implement first? Administer acetaminophen (Tylenol) 650 mg rectally. Draw blood for a complete blood count and serum electrolytes. Obtain a stool specimen for culture and sensitivity. Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.

Keeping a daily food diary Identifying emotional and situational factors that stimulate eating Increasing exercise (Self-monitoring techniques the nurse includes in the teaching plan are keeping a record of foods eaten (food diary), identifying emotional and situational factors that stimulate eating, and exercise patterns. Stimulus control involves controlling the external cues that promote overeating.Cognitive restructuring involves modifying negative beliefs by learning positive, not negative, coping self-statements. Healthy eating behaviors must be learned or modified by the client as an individual and not through copying or modeling others' behaviors.)

An obese client has been taking orlistat (Xenical) 60 mg orally three times a day for 4 weeks, but has only lost 10 pounds (4.5 kg). The health care provider doubles the dosage and recommends behavioral changes. What behavioral changes does the nurse include in the teaching plan? Select all that apply. Cognitive restructuring to learn negative coping statements Keeping a daily food diary Identifying emotional and situational factors that stimulate eating Increasing exercise Seeking behaviors in others that one can model

"It inhibits enzymes and changes the way your body digests fats. Because fats are only partially digested and absorbed, calorie intake is decreased." (The nurse explains to the client that Orlistat inhibits lipase and leads to partial hydrolysis of triglycerides. Because fats are only partially digested and absorbed, calorie intake is decreased.Orlistat does not decrease the amount of norepinephrine in the brain, increase the amount of serotonin in the brain, or alter the chemistry of the brain.)

An obese client is prescribed orlistat (Xenical). The client asks the nurse how the drug works. How does the nurse respond? "It decreases the amount of norepinephrine in your brain. This action will increase your feeling of being satisfied on less food." "It increases the amount of serotonin in your brain. This action will greatly increase your metabolic rate, and you will burn calories quicker." "It inhibits enzymes and changes the way your body digests fats. Because fats are only partially digested and absorbed, calorie intake is decreased." "It will alter the chemistry of your brain. Consequently, you will feel full before you overeat."

Reducing nutritional fat intake to less than 30% of the client's daily food intake. (The nurse recommends reducing nutritional fat intake to less than 30% of the client's daily food intake. Loose stools, abdominal cramps, and nausea are common side effects of orlistat and can be reduced by decreasing fat intake.Unless side effects persist or become more severe, it is not necessary to change the medication. Reducing the dose of orlistat does not affect these symptoms, since they are dependent on fat intake. Increasing the daily activity level helps with weight loss, but does not reduce side effects of Orlistat.)

An obese client with a body mass index of 30 and hypertension has been taking prescription orlistat for 4 weeks and reports loose stools, abdominal cramps, and nausea. What does the nurse recommend for this client? Asking the provider to change the medication to phendimetrazine (Bontril). Changing to the lower dose, over-the-counter form of orlistat to reduce these effects. Increasing the daily activity level to improve overall metabolism. Reducing nutritional fat intake to less than 30% of the client's daily food intake.

a. Cimetidine (Tagamet) (Sometimes H₂ receptor antagonists such as cimetidine may cause adverse effects related to the central nervous system in the older adult, including confusion and disorientation. The nurse needs to be alert for mental status changes when giving these drugs, especially if the changes are new to the patient.)

An older adult patient had gastric surgery due to a gastrointestinal bleed 3 days ago, and he has been stable since the surgery. This evening, his daughter tells the nurse, "He seems to be more confused this afternoon. He's never been like this. What could be the problem?" The nurse reviews the patient's medication record and suspects that which drug could be the cause of the patient's confusion? a. Cimetidine (Tagamet) b. Pantoprazole (Protonix) c. Clarithromycin (Biaxin) d. Sucralfate (Carafate)

b. Increase intake of calcium and vitamin D. (All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any medication and are not specific to the use of esomeprazole.)

An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client? a. Check with the pharmacist before taking other medications. b. Increase intake of calcium and vitamin D. c. Report any worsening of symptoms to the provider. d. Take the medication as prescribed by the provider.

d. ingestion of toxins produced by bacteria in the food before it is eaten. (Bacterial food poisoning is caused by the ingestion of bacterial toxins that have been produced in the food by the growth of specific kinds of bacteria before the food is eaten.)

Bacterial food poisoning is caused by a. ingestion of toxic bacteria. b. toxins produced by bacteria in the intestines. c. toxins produced by bacteria in the bloodstream. d. ingestion of toxins produced by bacteria in the food before it is eaten.

Woman with a BMI of 42, weight 100% above ideal body weight (The client who will be most successful with surgical intervention is the client with a BMI of 40 or more and a weight 100% above the ideal body weight.The other clients do not have a high enough BMI-to-weight ratio to be considered for surgical intervention.)

Based on nutritional screening findings and assessments, which client will be the preferred candidate for surgical treatment for obesity? Man with a body mass index (BMI) of 40, weight 75% above ideal body weight Man with a BMI of 41, weight 80% above ideal body weight Woman with a BMI of 38, weight 50% above ideal body weight Woman with a BMI of 42, weight 100% above ideal body weight

Hypertension Coronary heart disease Sleep apnea Respiratory problems (Being overweight or obese increases the risk for many diseases and health conditions, including hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, sleep apnea, and respiratory problems. These conditions increase risks for postoperative complications. Hypotension is not a complication of obesity.)

Being overweight or obese increases the risk for many diseases and health conditions, including which of the following? (Select all that apply.) Hypertension Coronary heart disease Sleep apnea Respiratory problems Hypotension

theophylline (Theo-Dur). (Anticholinergic drugs, calcium-channel blockers, and theophylline should be avoided, if possible, because they delay gastric emptying and can initiate manifestations of GERD.)

During a health interview, the nurse informs a client with GERD that of all the drugs the client is presently taking, the drug that will aggravate the clinical manifestations of GERD is digoxin (Lanoxin). furosemide (Lasix). rofecoxib (Vioxx). theophylline (Theo-Dur).

d. Masked symptoms of serious underlying diseases (Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as bleeding ulcer or malignancy. Patients with ongoing symptoms need to undergo regular medical evaluations, because additional medications or other interventions may be needed.)

During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for 1 year with over-the-counter Prilosec OTC (omeprazole, a proton pump inhibitor). The nurse is aware that this self-treatment may have which result? a. No serious consequences b. Prevention of more serious problems, such as an ulcer c. Chronic constipation d. Masked symptoms of serious underlying diseases

d. "Drink a full glass of water with each dose." (Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset; however, antacids and dairy products will bind with the tetracycline and make it inactive.)

During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? a. "Take it with cheese and crackers or yogurt." b. "Take each dose with a glass of milk." c. "Take an antacid with each dose as needed." d. "Drink a full glass of water with each dose."

Inhibits gastric acid secretion (Famotidine decreases gastric secretion by inhibiting histamine at H₂ receptors. Increases gastric motility, neutralizes gastric acidity, and facilitates histamine release are not actions of famotidine.)

Famotidine (Pepcid) is prescribed for a client with peptic ulcer disease. The client asks the nurse what this medication does. Which action does the nurse mention when replying? Increases gastric motility Neutralizes gastric acidity Facilitates histamine release Inhibits gastric acid secretion

Medicate the client for pain before coughing and deep breathing. (Analgesics limit pain, facilitating effective coughing and deep breathing. Although giving pain medication regularly may be necessary, it must be coordinated with the deep breathing and coughing exercises. Opioids depress the central nervous system (CNS), particularly respirations, and increasing the dose should be an option only after other interventions have been unsuccessful. Incentive spirometry will cause pain because it increases intraabdominal pressure, and the client may not cooperate if pain is not relieved.)

Following an abdominal cholecystectomy, the client refuses to take deep breaths and cough, saying, "It's too painful." What action does the nurse take? Give pain medication regularly as soon as possible. Obtain a prescription to increase the client's pain medication. Medicate the client for pain before coughing and deep breathing. Substitute incentive spirometry for coughing and deep breathing.

Magnesium-containing antacids (Magnesium-containing antacids can cause hypermagnesemia in clients with chronic renal failure. Aluminum-containing antacids may be used as a phosphate binder in clients with chronic renal failure. Sodium- and aluminum-containing antacids are chemically more easily excreted in clients with renal compromise. Although calcium-containing antacids may accumulate in the bloodstream of clients with renal failure, they may also be appropriate because these patients may be hypocalcemic.)

For a client with chronic renal failure, the nurse MOST likely will question a prescription for which type of antacid? Aluminum-containing antacids Calcium-containing antacids Sodium-containing antacids Magnesium-containing antacids

c. Client who is pregnant (Misoprostol can cause abortion, so pregnant women should not take this drug. The other clients have no contraindications to taking misoprostol.)

For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)? a. Client taking antacids b. Client taking antibiotics c. Client who is pregnant d. Client over 65 years of age

Dark urine Yellow skin Clay-colored stool (When bile levels in the bloodstream are high, as in obstructive jaundice, there is bile in the urine, causing it to have a dark color. Jaundice (bile pigments causing yellow skin, sclera, and mucous membranes) results from failure of bile to enter the intestines, with subsequent backup into the biliary system and diffusion into the blood; the bilirubin is carried to all body regions. The stools are clay-colored, not brown, because the bile pigments are not present in the gastrointestinal (GI) tract as a result of the obstruction of the common bile duct. Pain is experienced in the right upper quadrant, not on urination, because of spasm of the gallbladder, whether or not there is biliary obstruction. Coffee-ground vomitus indicates gastric bleeding; it is not a unique sign of cholelithiasis with obstructive jaundice.)

For which clinical indicators should the nurse monitor when caring for a client with cholelithiasis and obstructive jaundice? Select all that apply. Dark urine Yellow skin Pain on urination Clay-colored stool Coffee-ground vomitus

By forming a protective barrier over the gastric mucosa (Sucralfate has a local effect only on the gastric mucosa. It forms a protective barrier that can be thought of as a liquid bandage in the stomach. This liquid bandage adheres to the gastric lining, protecting against adverse effects related to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.)

How does sucralfate (Carafate) achieve a therapeutic effect? By inhibiting the production of gastric acid secretion By enhancing gastric absorption By forming a protective barrier over the gastric mucosa By neutralizing gastric acid

BMI = kg/meters² (The correct formula to accurately calculate a client's body mass index (BMI) is: BMI = weight (kg)/height (in meters)².)

How does the nurse accurately calculate a client's body mass index? (weight/height) BMI = kg/meters² BMI = lb/inches² BMI = kg/meters BMI = lb/meters

They irreversibly bind to the hydrogen-potassium-ATPase pump. (PPIs work to block the final step in the acid-secreting mechanisms of the proton pump. They do this by irreversibly binding to the ATPase pump, H⁺/K⁺ ATPase, the enzyme for this step.)

How will the nurse describe the action of proton pump inhibitors (PPIs)? They form a protective barrier that can be thought of as a liquid bandage. They irreversibly bind to the hydrogen-potassium-ATPase pump. They compete with histamine for binding sites on the parietal cells. They help to neutralize acid secretions to promote gastric mucosal defensive mechanisms.

Cultured dairy products such as yogurt (The natural flora in the GI tract may be killed off by antibiotics, leaving other bacteria such as C. difficile to overgrow. This process may be prevented through consumption of probiotics (e.g., yogurt, buttermilk, kefir).)

In an effort to prevent superinfections of the GI tract such as Clostridium difficile, the nurse will instruct clients to eat which foods? Cultured dairy products such as yogurt Low-fat meats such as chicken and pork Multigrain wheat bread Raw fruits and vegetables

"I have a terrible pain in my stomach; it is so bad I can feel it in my shoulder." (The most specific and characteristic manifestation of gallstone disease is pain, or biliary colic, which is caused by spasm of the biliary ducts as they try to dislodge stones. This pain usually follows the temporary obstruction of the gallbladder outlet. Characteristically, the pain starts in the upper midline area, and it may radiate around to the back and right shoulder blade, although some clients report that it passes straight through to the back and substernal areas.)

In evaluating a client for the presence of gallbladder disease, the nurse would recognize that the client's statement most suggestive of this problem is "I am having difficulty swallowing." "I get a sharp, stabbing pain every time I take a deep breath or cough." "I have a terrible pain in my stomach; it is so bad I can feel it in my shoulder." "I have a very strong craving for fatty foods like bacon and eggs fried in butter."

d. Place the patient on contact precautions. b. Assess blood pressure and heart rate. a. Contact the health care provider. c. Give the PRN acetaminophen (Tylenol). (Proton pump inhibitors including omeprazole (Prilosec) may increase the risk of Clostridium difficile-associated colitis. Because the patient's history and symptoms are consistent with C. difficile infection, the initial action should be initiation of infection control measures to protect other patients. Assessment of blood pressure and pulse is needed to determine whether the patient has symptoms of hypovolemia and/or shock. The health care provider should be notified so that actions such as obtaining stool specimens and antibiotic therapy can be started. Tylenol may be administered, but is the lowest priority of the actions.)

In which order will the nurse take the following actions when caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec) therapy? a. Contact the health care provider. b. Assess blood pressure and heart rate. c. Give the PRN acetaminophen (Tylenol). d. Place the patient on contact precautions.

decreases the time food and fluids are in my stomach." (Metoclopramide may be prescribed because it increases LES pressure by stimulating the smooth muscle of the gastrointestinal tract and increasing the rate of gastric emptying. It has no effect on gastric acidity, no anesthetic effects, and does not work in the esophagus.)

Metoclopramide (Reglan) is prescribed for a client with GERD. The nurse realizes that teaching about this drug has been effective when the client says "I understand metoclopramide acts as an antacid to reduce gastric acidity." decreases the time food and fluids are in my stomach." has a local anesthetic effect on the esophagus and stomach." helps to promote movement in the esophagus."

d. dumping syndrome. (Dumping syndrome is a frequently encountered complication after extensive gastric resection. After the initial recovery from surgery, when the patient begins to feel better and eats a regular diet in greater volume and variety, discomfort may occur 30 to 60 minutes after meals. A cramping and full feeling develops, the pulse becomes rapid, and a wave of weakness, cold sweating, and dizziness may follow.)

Ms. Jones has recently had gastric surgery and 45 minutes after eating her regular diet she feels cramping and full with waves of weakness and dizziness. Ms. Jones is most likely experiencing a. a heart attack. b. a gallbladder attack. c. a pulmonary embolus. d. dumping syndrome.

c. lowering fat intake. (A low-fat intake may help avoid pain and discomfort because the presence of fat entering the small intestine stimulates the contraction of the gallbladder.)

Nutrition therapy for gallbladder disorders includes a. reducing cholesterol intake. b. eliminating gas-forming foods. c. lowering fat intake. d. increasing caloric intake.

c. chocolate cookies. (The complex of symptoms in dumping syndrome constitutes a shock syndrome that results when a meal containing a large portion of readily soluble carbohydrates rapidly enters, or "dumps" into the small intestine.)

Of the following, the food item most likely to lead to dumping syndrome is a. lean meat. b. butter. c. chocolate cookies. d. whole wheat toast.

Achlorhydria (Because PPIs stop the final step of acid secretion, they can block up to 90% of acid secretion, leading to achlorhydria (without acid).)

PPIs have the ability to almost totally inhibit gastric acid secretion. Because of this possibility, the use of the medication can lead to what condition? Gastric ulcer formation Gastroesophageal reflux disease (GERD) Achlorhydria Diverticulosis

Nitroglycerin (Nitrostat) (Sildenafil and other drugs for erectile dysfunction should not be taken with nitroglycerin because it may lead to a significant hypotension that could be life threatening.)

Patients prescribed sildenafil (Viagra) should be instructed regarding the potential life-threatening drug interaction with which medication? Aspirin (Acetylsalicylic acid) Acetaminophen (Tylenol) Warfarin (Coumadin) Nitroglycerin (Nitrostat)

d. water being drawn from the blood into the intestine and decreasing the blood volume. (Dumping syndrome results when a meal containing a large portion of readily soluble carbohydrates rapidly enters, or "dumps," into the small intestine. This rapidly entering food mass is a concentrated solution in relation to the surrounding circulation of blood. To achieve an osmotic balance, water is drawn from the blood into the intestine. This water shift rapidly shrinks the vascular fluid volume. As a result, blood pressure drops and signs of rapid heart action to rebuild the blood volume appear.)

Physiologic symptoms of dumping syndrome result from a. the intestinal contents being absorbed too quickly. b. the ingested food remaining in the stomach too long. c. the stomach emptying too quickly into the intestine. d. water being drawn from the blood into the intestine and decreasing the blood volume.

Inhibiting the histamine at H₂ receptors (Ranitidine inhibits histamine at H₂ receptor sites in parietal cells, which limits gastric secretion. Lowering the gastric pH is not the direct action of this drug. Promoting the release of gastrin is undesirable; gastric hormones increase gastric acid secretion. Ranitidine does not regenerate the gastric mucosa; the drug prevents its erosion by gastric secretions.)

Ranitidine has been prescribed to help treat a client's gastric ulcer. The nurse expects this drug to act specifically by which mechanism? Lowering the gastric pH Promoting the release of gastrin Regenerating the gastric mucosa Inhibiting the histamine at H₂ receptors

b. State "That is a violation of client confidentiality." (Ethical practice requires the nurse to speak up and tell the other nurse that he or she is violating client confidentiality rules. The other responses do not address this concern.)

Several nurses have just helped a morbidly obese client get out of bed. One nurse accesses the client's record because "I just have to know how much she weighs!" What action by the client's nurse is most appropriate? a. Make an anonymous report to the charge nurse. b. State "That is a violation of client confidentiality." c. Tell the nurse "Don't look; I'll tell you her weight." d. Walk away and ignore the other nurse's behavior.

Adolescent with an erection for "10 or 11 hours" who is reporting severe pain (The nurse first attends to the client who has had an erection for "10 or 11 hours." This client has symptoms of priapism which is considered a urologic emergency because the circulation to the penis may be compromised. With an erect penis, the client may also be unable to void.The client with a swollen, painful scrotum, the client with hematuria, and the client with a history of benign prostatic hyperplasia do not require the nurse's immediate attention.)

The RN working in the hospital emergency department is assigned to care for these four clients. Which client does the nurse attend to first? Adolescent with an erection for "10 or 11 hours" who is reporting severe pain Young adult with a swollen, painful scrotum who has a recent history of mumps infection Middle-aged adult discharged 2 days ago after a transurethral resection of the prostate who has increased hematuria Older adult with a history of benign prostatic hyperplasia and palpable bladder distention

Primary prevention (This intervention would be considered primary prevention, as poor eating habits may lead to obesity and chronic diseases such as diabetes later in life.)

The community/public health nurse invites a dietitian to a healthy lifestyles program to discuss fun ways to eat vegetables and fruits as snacks. Which of the following best describes this nursing intervention? Disability limitation Primary prevention Secondary prevention Tertiary prevention

Omeprazole (Prilosec) (Proton pump inhibitors such as omeprazole are the main treatment for more severe cases of GERD. Gaviscon, Axid, and Zantac can be used to treat less severe cases.)

The health care provider is prescribing medication to treat a client's severe gastroesophageal reflux disease (GERD). Which medication does the nurse anticipate teaching the client about? Magnesium hydroxide (Gaviscon) Ranitidine (Zantac) Nizatidine (Axid) Omeprazole (Prilosec)

Chicken and rice (Chicken and rice is the best sample meal for this patient. It is the only selection suitable for the patient who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products.The patient with dumping syndrome would not be allowed to have mayonnaise, onions, or buttermilk ranch dressing. Buttermilk dressing is made from milk products. The patient can have whole wheat bread only in very limited amounts.)

The nurse and the dietitian are planning sample diet menus for a patient who is experiencing dumping syndrome. Which sample meal is best for this patient? Chicken salad on whole wheat bread Liver and onions Chicken and rice Cobb salad with buttermilk ranch dressing

Obstructive sleep apnea (Obstructive sleep apnea (OSA) occurs when the muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing airflow or stopping it for as long as 30 seconds. The person still attempts to breathe because chest and abdominal movements continue, resulting in snoring or snorting sounds. With narcolepsy, the person feels an overwhelming wave of sleepiness and falls asleep. Insomnia is characterized by chronic difficulty falling asleep. Sleep deprivation is a condition caused by dyssomnia. OSA is the only one of these conditions that results in blockage of the airway and impacts the ability to breathe.)

The nurse assigns a nursing diagnosis of ineffective breathing pattern. Which of the following sleep conditions would support this diagnosis? Insomnia Narcolepsy Obstructive sleep apnea Sleep deprivation

c. Mucosal barrier fortifier (Sucralfate is a mucosal barrier fortifier (protector). It is not a gastric acid inhibitor, a histamine receptor blocker, or a proton pump inhibitor.)

The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)? a. Gastric acid inhibitor b. Histamine receptor blocker c. Mucosal barrier fortifier d. Proton pump inhibitor

a. "I just joined a gym, so I hope that helps me lose weight." b. "I sure hate to give up my coffee, but I guess I have to." c. "I will eat three small meals and three small snacks a day." d. "Sitting upright and not lying down after meals will help." (Lifestyle modifications can help control GERD and include losing weight if needed; avoiding chocolate, caffeine, and carbonated beverages; eating frequent small meals or snacks; and remaining upright after meals. Tobacco is a risk factor for GERD and should be avoided in all forms.)

The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.) a. "I just joined a gym, so I hope that helps me lose weight." b. "I sure hate to give up my coffee, but I guess I have to." c. "I will eat three small meals and three small snacks a day." d. "Sitting upright and not lying down after meals will help." e. "Smoking a pipe is not a problem and I don't have to stop."

Dyspepsia Excessive salivation Flatulence Regurgitation (When assessing a patient for GERD, the nurse expects to find dyspepsia (heartburn), excessive salivation, flatulence which is common after eating, and regurgitation (backward flow of food and fluid into the throat).Blood-tinged sputum is not a symptom of GERD.)

The nurse is assessing a patient with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe? Select all that apply. Blood-tinged sputum Dyspepsia Excessive salivation Flatulence Regurgitation

Using an alcohol-based hand rub after caring for a client with diarrhea (Alcohol-based hand rubs are not effective against spore-forming organisms such as Clostridium difficile, which is a common cause of diarrhea among hospitalized clients. The nursing assistant should wash hands with soap after caring for such clients in case they have an undiagnosed infection with this bacterium. The other actions are appropriate.)

The nurse is assigned to work with a new nursing assistant. Which action by the nursing assistant requires intervention by the registered nurse? Using an alcohol-based hand rub after caring for a client with diarrhea Washing hands for 20 seconds using warm water and friction Cleaning especially carefully under fingernails and around a wedding band Using chlorhexidine for handwashing when caring for clients on neutropenic precautions

a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity (Many factors predispose a person to GERD, including delayed gastric emptying, eating large meals, hiatal hernia, and obesity. Viral infections are not implicated in the development of GERD, although infection with Helicobacter pylori is.)

The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections

Emesis of bile-colored fluid past the nasogastric (NG) tube (Vomiting with an NG tube in place indicates that the NG tube needs to be repositioned by the surgeon to avoid putting stress on the gastric sutures. The nurse should implement actions to decrease skin irritation and have the patient cough and deep breathe, but these do not indicate a need for rapid notification of the surgeon. Frequent PCA use after bariatric surgery is expected.)

The nurse is caring for a 54-year-old female patient on the first postoperative day after a Roux-en-Y gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon? Bilateral crackles audible at both lung bases Redness, irritation, and skin breakdown in skinfolds Emesis of bile-colored fluid past the nasogastric (NG) tube Use of patient-controlled analgesia (PCA) several times an hour for pain

Assess puncture sites for bleeding (The one to four puncture sites used to perform the surgery laparoscopically should be monitored for any possible bleeding. There will not be an abdominal dressing unless a traditional cholecystectomy is performed. Patient-controlled analgesia is not necessary as there is no abdominal incision. Activity restriction is about one week with a laparoscopic cholecystectomy.)

The nurse is caring for a client following a laparoscopic cholecystectomy. Which nursing action is priority? Monitor the abdominal dressing for bleeding Instruct on using patient-controlled analgesia Teach about six-week activity restriction Assess puncture sites for bleeding

Encourage turning, coughing, and deep breathing exercises Perform frequent breath sounds assessment (This client likely has postoperative atelectasis and requires frequent breath sounds assessment because of the presence of adventitious breath sounds. Also, the client should turn, cough, and deep breathe to prevent further atelectasis and pneumonia. The client may be encouraged to increase intake to facilitate thinning of any secretions that may be present. High-potassium diet will have no effect on the resolution of atelectasis. Obtaining a chest x-ray is not a nursing action and requires a healthcare provider prescription; the nurse can review or request an x-ray.)

The nurse is caring for a client who is postoperative day 2 from an open cholecystectomy and notes the presence of bibasilar crackles. The nurse suspects atelectasis. Which nursing actions will be appropriate for this client? Select all that apply . Encourage turning, coughing, and deep breathing exercises Perform frequent breath sounds assessment Decrease by mouth fluid intake Offer a high-potassium diet Obtain a chest x-ray

"I will not drink fluids when I eat meals." "I will avoid sweetened and spicy foods." "I will eat small, frequent meals instead of three large meals a day." (Total fluid intake does not have to be restricted; however, fluids should not be taken immediately before, during, or after a meal because they promote rapid stomach emptying. It is safe to take fluids before or after meals. Concentrated sweets pass rapidly out of the stomach and increase fluid shift; spicy foods may cause gastric irritation; both sweetened and spicy food should be avoided. Dumping syndrome after gastric surgery is managed by nutrition changes that include decreasing the amount of food taken at one time. Small feedings reduce the amount of bulk passing into the jejunum and therefore reduce the fluid that shifts into the jejunum. A bland diet is not necessary. The diet should be low to moderate in carbohydrates, high in protein, and high in fat to promote tissue repair and provide energy.)

The nurse is caring for a client who is scheduled for a gastric bypass to treat morbid obesity. Which statement by the client indicates a good understanding of preventing dumping syndrome after meals? Select all that apply . "I will eat a bland diet." "I will not drink fluids when I eat meals." "I will avoid sweetened and spicy foods." "I will eat a low-protein, high-carbohydrate diet." "I will eat small, frequent meals instead of three large meals a day."

Penile implants (Penile implants (prostheses), which require surgery, are used when other modalities fail. Devices include semirigid, flexible, or hydraulic inflatable and multicomponent or one-piece instruments.Penile injections and transurethral suppositories are tried before using the option of last resort. A vacuum constriction device is easy to use and is often the first option that is tried.)

The nurse is caring for a client with erectile dysfunction who has not had success with common treatment modalities. The nurse anticipates that the primary health care provider will recommend which treatment for this client? Penile implants Penile injections Transurethral suppository Vacuum constriction device

b. Notify the health care provider immediately. (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.)

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.

Instructing the client to drink 8 to 10 glasses of water daily (Increasing fluid intake dilutes the urine, and crystals are less likely to coalesce and form calculi. An elevated serum creatinine has no relationship to the formation of renal calculi. Calcium restriction is necessary only if calculi have a calcium phosphate basis. Producing only 2000 mL of urine per 24 hours is inadequate.)

The nurse is caring for a client with ureteral colic. To prevent the development of renal calculi in the future, which strategy should be included in the client's plan of care? Instructing the client to drink 8 to 10 glasses of water daily Interventions to decrease the serum creatinine level A urinary output goal of 2000 mL per 24 hours Excluding milk products from the diet

"Your weight is a few pounds over the ideal for your height." (The client's BMI is 28.4, indicating that the client is overweight. However, he is not obese. The nurse should not state that the client's weight is just about right, a few pounds under, or quite a bit over the ideal weight for his height.)

The nurse is caring for a male client who is 6 feet, 1 inch tall and weighs 215 pounds. The client asks the nurse if his weight is appropriate for his height. Which is the nurse's best response? "Your weight is just about right for someone your height." "Your weight is a few pounds under the ideal for your height." "Your weight is a few pounds over the ideal for your height." "Your weight is quite a few pounds over the ideal for your height."

2,000 mL (Unless contraindicated by renal failure or hydronephrosis, patients with renal stones should drink at least eight 8-ounce glasses of water daily or have IV fluids prescribed to keep the urine dilute. A urine output exceeding 2 L a day is advisable.)

The nurse is caring for a patient recently diagnosed with renal calculi. The nurse should instruct the patient to increase fluid intake to a level where the patient produces at least how much urine each day? 1,250 mL 2,000 mL 2,750 mL 3,500 mL

Encourage fluid intake up to 4000 mL every day. (To decrease the risk for renal calculi, the patient should have a fluid intake of 3000 to 4000 mL daily. Ambulation helps decrease the loss of calcium from bone and is encouraged in patients with hypercalcemia. Trousseau's and Chvostek's signs are monitored when there is a possibility of hypocalcemia. There is no indication that the patient needs frequent assessment of lung sounds, although these would be assessed every shift.)

The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan? Maintain the patient on bed rest. Auscultate lung sounds every 4 hours. Monitor for Trousseau's and Chvostek's signs. Encourage fluid intake up to 4000 mL every day.

Instruct assistive personnel to use soap and water rather than sanitizer to clean hands. (Clostridium difficile is a spore-forming organism that can be transmitted through direct and indirect patient contact. Because Clostridium difficile is a spore-forming organism, hand sanitizer is not effective in preventing its transmission. Hands must be washed with soap and water to prevent transmission. This organism is not transmitted via the droplet route; therefore Droplet Precautions are not needed. An N95 respirator is used primarily for patients with airborne illness. All patients should be taught cough etiquette; this action is not one to be take especially because the patient has Clostridium difficile.)

The nurse is caring for a patient who has cultured positive for Clostridium difficile. Which of the following nursing actions would be appropriate given this organism? Instruct assistive personnel to use soap and water rather than sanitizer to clean hands. Place the patient on Droplet Precautions. Wear an N95 respirator when entering the patient room. Teach the patient cough etiquette.

d. Ketoconazole (Nizoral) (All H₂ receptor antagonists may inhibit the absorption of certain drugs, such as the antifungal ketoconazole, that require an acidic gastrointestinal environment for gastric absorption. The other options are incorrect.)

The nurse is reviewing the medication orders for a patient who will be taking an H₂ antagonist. Which drug may have an interaction if taken along with the H₂ antagonist? a. Ibuprofen (Motrin) b. Ranitidine (Zantac) c. Tetracycline (Doryx) d. Ketoconazole (Nizoral)

Choking and noisy, irregular respirations (One of the greatest concerns after general anesthesia is airway obstruction. Choking and noisy, irregular respirations are classic signs and symptoms of airway obstruction. A number of factors contribute to obstruction, including a history of obstructive sleep apnea; weak pharyngeal/laryngeal muscle tone from anesthetics; secretions in the pharynx, bronchial tree, or trachea; and laryngeal or subglottic edema. In the postanesthetic patient, the tongue is a major cause of airway obstruction. Shallow respirations are indicative of respiratory depression. Moaning and reports of pain are common in all surgical patients and are an expected event. Disorientation is common when first awakening from anesthesia but can be a sign of hypoxia.)

The nurse is caring for a postoperative patient with a history of obstructive sleep apnea. The nurse monitors for which of the following? Choking and noisy, irregular respirations Shallow respirations Moaning and reports of pain Disorientation

"I may have loose stools after meals if I eat too much fat." (Orlistat (Xenical) inhibits lipase, leading to partial hydrolysis of triglycerides. Fats are only partially digested and absorbed and are excreted in the feces. The client may experience nausea, cramps, and loose stools when fats are increased in the diet. Orlistat does not increase metabolism, suppress appetite, or make the client feel full after small meals.)

The nurse is caring for an obese client who will be taking orlistat (Xenical) to help her lose weight. Which statement indicates that the client understands teaching about orlistat? "This medication will help speed up my metabolism." "I may have loose stools after meals if I eat too much fat." "This medication will suppress my appetite so I won't be hungry." "This medication will make me feel full after I eat small amounts."

Maintain IV fluids. (Dehydration can occur quickly in older clients with Salmonella food poisoning caused by diarrhea, so maintenance of fluid balance is a high priority. Monitoring vital signs and providing perineal care are important nursing actions, but are of lower priority than fluid replacement. Contact Isolation is not regularly instituted for Salmonella infection. Standard Precautions are usually sufficient.)

The nurse is caring for an older client with Salmonella food poisoning. Which is the priority action of the nurse? Monitor vital signs. Maintain IV fluids. Provide perineal care. Initiate Isolation Precautions.

The client started taking dexamethasone (Decadron) daily. (Dexamethasone is a corticosteroid. These drugs alter carbohydrate, protein, and lipid metabolism, predisposing the client to obesity when taken on a long-term basis. In addition, corticosteroids increase the client's appetite. Naprosyn is an NSAID, which can lead to gastric upset and ulceration and decreased appetite and weight loss. The client's glycosylated hemoglobin and thyroid levels are within normal limits and would not explain the hunger and weight gain.)

The nurse is caring for an overweight client who gained 10 pounds during the previous 2 weeks. The client states that she is hungry all the time and doesn't understand why. Which assessment finding could explain the client's weight gain and hunger? The client started taking dexamethasone (Decadron) daily. The client started taking naproxen sodium (Naprosyn) daily. The client's glycosylated hemoglobin level is 6%. The client's thyroxine (T₄) level is 8 mcg/dL.

Walking for 40 minutes 6 or 7 days/week (Exercise should be done daily for 30 minutes to an hour. Exercising in highly aerobic activities for short bursts or only once a week is not helpful and may be dangerous in an individual who has not been exercising. Running may be appropriate, but a patient should start with an exercise that is less stressful and can be done for a longer period. Weight lifting is not as helpful as aerobic exercise in weight loss.)

The nurse is coaching a community group for individuals who are overweight. Which participant behavior is an example of the best exercise plan for weight loss? Walking for 40 minutes 6 or 7 days/week Lifting weights with friends 3 times/week Playing soccer for an hour on the weekend Running for 10 to 15 minutes 3 times/week

"Do you snore loudly or experience headaches?" (To assess for sleep apnea, the nurse may ask, "Do you snore loudly?" and, "Do you experience headaches after awakening?" A positive response may indicate that the client experiences sleep apnea. This question is directed at assessing the potential presence of insomnia. This question is directed at determining the potential presence of narcolepsy. This question is directed at determining the potential presence of narcolepsy.)

The nurse is completing an assessment on the client's sleep patterns. A specific question that the nurse should ask to determine the potential presence of sleep apnea is: "How easily do you fall asleep?" "Do you have vivid, lifelike dreams?" "Do you ever experience loss of muscle control or falling?" "Do you snore loudly or experience headaches?"

Sleeping on two to three pillows at night (To achieve a short-term goal, the nurse should plan a lifestyle change that the patient can make immediately that will have a quick effect. Sleeping on several pillows at night will immediately relieve orthopnea and open the patient's airway, thereby reducing sleep apnea and reducing fatigue. Running 30 minutes a day will improve cardiopulmonary health, but a patient needs to build up exercise tolerance. Smoking cessation is another process that many people have difficulty doing immediately. It often occurs as a slow progression, beginning with reduction of frequency. A more realistic short-term goal would be to gradually reduce the number of cigarettes smoked. Limiting caloric intake can help a patient lose weight, but this is a gradual process and is not reasonable for a short-term goal.)

The nurse is creating a plan of care for an obese patient who is suffering from fatigue related to ineffective breathing. Which intervention best addresses a short-term goal that the patient could achieve? Running 30 minutes every morning Stopping smoking immediately Sleeping on two to three pillows at night Limiting the diet to 1500 calories a day

Vardenafil (Levitra) Tadalafil (Cialis) (Phosphodiesterase inhibitors (PDIs) are used in the treatment of erectile dysfunction. Sildenafil (Viagra) was the first oral drug approved for the treatment of erectile dysfunction. Two drugs that are similar but have a longer duration of action are vardenafil (Levitra) and tadalafil (Cialis). Collectively, these drugs are referred to as erectile dysfunction drugs. Avanafil (Stendra) is the newest PDI approved for erectile dysfunction. A second type of drug used to treat erectile dysfunction is the prostaglandin alprostadil (Caverject). This drug must be given by injecting it directly into the erectile tissue of the penis or pushing a suppository form of the drug into the urethra.)

The nurse is educating a patient about medications used to treat erectile dysfunction. Which erectile dysfunction medications have the longest therapeutic effect when taken orally? (Select all that apply.) Avanafil (Stendra) Alprostadil (Caverject) Vardenafil (Levitra) Tadalafil (Cialis) Sildenafil (Viagra)

"Consume a diet that is moderate in salt and sugar and low in fats and cholesterol." "Eat a variety of foods, especially grain products, vegetables, and fruits." "Engage in moderate physical activity for at least 30 minutes each day." "Foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home." (Lifestyle changes the nurse emphasizes include consuming a diet that is moderate in salt and sugar and low in fats and cholesterol, and moderate physical activity for at least 30 minutes each day. These are smart strategies for a person who wants to lose weight. Eating a variety of foods, especially grain products, vegetables, and fruits, helps people achieve weight loss. These are foods that "burn" more calories as they are metabolized. Many foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home. When dining out, people can make smart choices, but they have to be educated and careful.A weight-training program for building muscle mass does not need to be included in a weight loss program. Muscle weighs more and tends to increase weight in people who weight-train. Liquid dietary supplements cannot safely be substituted for solid food while attempting to lose weight.)

The nurse is instructing a group of overweight clients on the complications of obesity that develop when weight is not controlled through diet and exercise. Which lifestyle changes does the nurse emphasize? Select all that apply. "Begin a weight-training program for building muscle mass." "Consume a diet that is moderate in salt and sugar and low in fats and cholesterol." "Eat a variety of foods, especially grain products, vegetables, and fruits." "Engage in moderate physical activity for at least 30 minutes each day." "Foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home." "Liquid dietary supplements can be substituted safely for solid food while attempting to lose weight."

"Tell me what you do to relieve stress in your daily life." (The best way to assess a client's response to obesity and stress is to say, "Tell me what you do to relieve stress in your daily life." This open-ended type of question is best because it cannot be answered with a "yes" or "no."Asking the client about mental health problems will cause the client to feel uncomfortable with the assessment; problems in handling stress do not mean mental health or depression problems. More effective methods can be used to determine the client's alcohol and drug habits. Having the client tell you what makes him or her uncomfortable about obesity will only cause the client to restate the obvious. It does not determine the effect that stress has on the client.)

The nurse is performing a health assessment on an obese client who states, "I have tried many diets in an effort to lose weight, but have been unsuccessful." How does the nurse assess whether the client's response to stress is related to the client's obesity? "Do you have a history of mental problems, especially depression?" "Do you usually use alcohol or drugs when you feel stressed?" "Tell me what you do to relieve stress in your daily life." "What is it about your obesity that causes you to feel uncomfortable?"

Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring (Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring is the correct nursing diagnosis. The medical diagnosis of obstructive sleep apnea should not be used in the nursing diagnosis.)

The nurse is preparing a care plan for a patient recently diagnosed with obstructive sleep apnea. The patient complains of daytime sleepiness, fatigue and excessive snoring that "wakes me up". What nursing diagnosis would be appropriate for this patient? Disturbed Sleep Pattern as evidenced by complaints of daytime sleepiness Disturbed Sleep Pattern related to obstructive sleep apnea as evidenced by excessive snoring Disturbed Sleep Pattern related to periods of apnea as evidenced by excessive snoring Disturbed Sleep Pattern related to obstructive sleep apnea

Practice of proper hand hygiene by all staff (Poor hand hygiene and erratic disinfection practices result in the transmission of C. difficile. Stool cultures are useful in the diagnosis, not the prevention, of C. difficile. Although the other options are appropriate, they do not have the most impact on preventing the spread of these bacteria.)

The nurse is providing ancillary personnel with instructions regarding the proper methods to implement when caring for a client with a Clostridium difficile infection. Which of the following practices will have the greatest impact on containment of the bacteria and thus prevention of cross-contamination? Frequent in-services on transmission modes of C. difficile Practice of proper hand hygiene by all staff Appropriate handling of contaminated linen Stool cultures on all suspected carriers

b. Antacids neutralize acid in the stomach. c. Rebound hyperacidity may occur with calcium-based antacids. e. Magnesium-based antacids cause diarrhea. (Antacids neutralize acid in the stomach. Magnesium-based antacids cause diarrhea, and aluminum-based antacids cause constipation. Calcium-based antacids often cause rebound hyperacidity.)

The nurse is providing patient teaching about antacids. Which statements about antacids are accurate? (Select all that apply.) a. Antacids reduce the production of acid in the stomach. b. Antacids neutralize acid in the stomach. c. Rebound hyperacidity may occur with calcium-based antacids. d. Aluminum-based antacids cause diarrhea. e. Magnesium-based antacids cause diarrhea.

a. "Avoid direct sunlight and tanning beds while on this medication." (Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill.)

The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? a. "Avoid direct sunlight and tanning beds while on this medication." b. "Milk and cheese products result in increased levels of tetracycline." c. "Antacids taken with the medication help to reduce gastrointestinal distress." d. "Take the medication until you are feeling better."

Changing to a twice-daily dosing regimen (The nurse contacts the primary health care provider about changing the Proton pump inhibitor to twice daily. These medications are usually effective when given once daily but can be given twice daily if symptoms are not well controlled.Adding a second medication, increasing the dose, or switching to another proton pump inhibitor is not recommended.)

The nurse is reviewing the medication history for a patient diagnosed with gastroesophageal reflux disease (GERD) who has been prescribed esomeprazole (Nexium) once daily. The patient reports that this proton pump inhibitor medication doesn't completely control the symptoms. The nurse contacts the primary health care provider to discuss which intervention? Adding a second proton pump inhibitor medication Increasing the dose of esomeprazole Changing to a twice-daily dosing regimen Switching to omeprazole (Prilosec)

"Walking 30 to 40 minutes provides the same benefit as long periods of exercise." (The nurse advises the class of older adults to walk 30 to 40 minutes five days per week. Although some people think that regular exercise has to include joining a fitness program or exercising for long periods of time, simple forms of exercise like walking can provide the same type of benefit. Older adults can engage in this type of exercise which does not cost anything (unlike joining a program) and provides health benefits such as strengthening joints and improving cardiovascular health.One to two hours of cardiovascular exercise every day is not required to achieve benefits of exercise. Joining a gym is not necessary. In addition, many older adults have a fixed income and cannot afford memberships. A 30-minute walk can be accomplished with a group (such as "mall walking") or alone.)

The nurse is teaching a class of older adults in the community about engaging in "regular" exercise. What does the nurse advise them? "One to two hours of cardiovascular exercise every day is a good idea." "Joining a fitness program or gym will help greatly with your exercise." "Walking 30 to 40 minutes provides the same benefit as long periods of exercise." "You will benefit most if you get into a group that shares your exercise goals."

Turkey sandwich on wheat bread (Turkey is an appropriate low-fat selection for this client. High fiber, from the wheat bread, also helps reduce the risk. Typically, diets high in fat, high in calories, low in fiber, and high in refined white carbohydrates place clients at higher risk for developing gallstones.Steak, French fries, fried chicken and mashed potatoes, and sausage are too fatty. Eggs are too high in cholesterol for a client with gallbladder disease.)

The nurse is teaching a client with gallbladder disease about diet modification. Which meal does the nurse suggest to the client? Steak and French fries Fried chicken and mashed potatoes Turkey sandwich on wheat bread Sausage and scrambled eggs

Adults should focus on variety and nutrient density and not calories. (The nurse emphasizes the need to focus on "shifts" to include a variety of nutrient-dense foods rather than less nutritious foods. The focus involves the client making active choices. This strategy is included in the 2015-2020 Dietary Guidelines for Americans. Examples of other guidelines are listed in Table 60-1.The most recent guidelines in 2015-2020 do not recommend that half of the diet include proteins and dairy. Using the My Plate recommendations, half of the diet should be fruits and vegetables. Lacto-ovarian diets are not emphasized. A multivitamin with iron and B12 is not recommended if the diet is adequate.)

The nurse is teaching a group of adults in the community about the 2015-2020 Dietary Guidelines for Americans. What does the nurse emphasize as a dietary strategy suggested in these guidelines? Half of each meal should consist of dairy, fruits, and proteins. Adults should focus on variety and nutrient density and not calories. Older adults should consider lacto-ovarian diets for improved health. Adults should include a multivitamin with iron and vitamin B12 in their diet.

Infertility Rheumatoid arthritis Cervical cancer Hypothyroidism (Sleep apnea and cholecystitis are potential health risks that can occur as a result of obesity. The other conditions are not caused by obesity.)

The nurse is teaching a health promotion class about weight loss and asks students to list health risks that can occur as a result of obesity. Which student responses indicate that additional teaching is required? (Select all that apply.) Sleep apnea Infertility Rheumatoid arthritis Cervical cancer Cholecystitis Hypothyroidism

"My goal should be to get my BMI below 18.5." (The client statement showing a need for further instruction is, "My goal should be to get my BMI below 18.5." The least risk for malnutrition is associated with scores between 18.5 and 25.Older adults need to have a BMI between 23 and 27. The client with a BMI greater than 24.9 does have increased health risks that a client with a lower number would not have. The client's BMI of 27.5 does mean that an increased amount of fat is stored in the body in relation to the client's height.)

The nurse is teaching a middle-aged adult client with a body mass index (BMI) of 27.5 and a height of 5'2" (157.5 cm) about what the BMI number means, and about malnutrition. Which client statement indicates a need for further instruction? "If I could get my BMI below 25, my risk for malnutrition would decrease." "I realize that this means that I have some increased health risks." "My goal should be to get my BMI below 18.5." "This means that I have an increased amount of total fat stored in my body."

"I can eat ice cream in moderation." (A need for further teaching about dietary changes related to dumping syndrome is indicated when the patient says that ice cream can be eaten in moderation. Milk products such as ice cream must be eliminated from the diet of a patient with dumping syndrome.The patient with dumping syndrome can no longer consume sweetened drinks. Alcohol must also be eliminated from the diet. The patient can eat sugar-free pudding, custard, and gelatin but with caution.)

The nurse is teaching a patient about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the patient indicates a need for further teaching? "I will need to avoid sweetened fruit juice beverages." "I can eat ice cream in moderation." "I cannot drink alcohol at all." "It is okay to have a serving of sugar-free pudding."

d. sildenafil (Viagra) (Sildenafil is a drug for erectile dysfunction and works by dilating blood vessels. When taken with an alpha blocker, sildenafil can cause a very rapid drop in blood pressure to the extent that the patient may fall or pass out.)

The nurse is teaching a patient who has just been prescribed prazosin (Minipres) for hypertension. The nurse immediately notifies the prescriber and questions the order upon discovering that the patient is also taking which drug? a. aspirin b. atenolol (Tenormin) c. chlorothiazide (Diuril) d. sildenafil (Viagra)

d. Long-term use of these drugs may contribute to osteoporosis. (New concerns have arisen over the potential for long-term users of proton pump inhibitors (PPIs) to develop osteoporosis. This is thought to be due to the inhibition of stomach acid, and it is speculated that PPIs speed up bone mineral loss. The other options are incorrect.)

The nurse is teaching a patient who will be taking a proton pump inhibitor as long-term therapy about potential adverse effects. Which statement is correct? a. Proton pump inhibitors can cause diarrhea. b. These drugs can cause nausea and anorexia. c. Proton pump inhibitors cause drowsiness. d. Long-term use of these drugs may contribute to osteoporosis.

"Nizatidine (Axid) needs to be taken three times a day to be effective." (Further discharge teaching is needed when the patient says that Nizatidine works best when taken three times a day. Nizatidine is most effective if administered once daily.A dose of ranitidine at bedtime would decrease acid production throughout the night. Sucralfate is taken 1 hour before and 2 hours after meals. Because omeprazole is a delayed-release capsule, it needs to be swallowed whole and not crushed.)

The nurse is teaching a patient with peptic ulcer disease (PUD) about the prescribed drug regimen. Which statement made by the patient indicates a need for further teaching before discharge? "Nizatidine (Axid) needs to be taken three times a day to be effective." "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." "Omeprazole (Prilosec) should be swallowed whole and not crushed."

Urine output total is 15 mL for the past 2 hours. (The nurse reports a urine output total of 15 mL for the past two hours. Normal urine output needs to be at least 30 mL per hour. Oliguria (scant urine output) may indicate severe postoperative complications such as anastomotic leaks or acute kidney failure.Inaudible bowel sounds would typically require intervention, but on the day of surgery, bowel sounds will probably be absent normally for some time. The other findings, excoriated skin under the panniculus and subjective reports of pain, may require nursing interventions, but do not require an immediate report to the surgeon.)

The nurse obtains assessment data on a client who had bariatric surgery today. Which finding does the nurse report to the surgeon immediately? Bowel sounds are not audible in all quadrants. Client's skin under the panniculus is excoriated. The client reports pain when being repositioned. Urine output total is 15 mL for the past 2 hours.

Restrict protein intake as ordered. (Protein is restricted to 60 g/d, while sodium is restricted to 3 to 4 g/d. Low-calcium diets are generally not recommended except for true absorptive hypercalciuria. The patient should avoid intake of oxalate-containing foods and there is no need to increase potassium intake.)

The nurse on a urology unit is working with a patient who has been diagnosed with oxalate renal calculi. When planning this patient's health education, what nutritional guidelines should the nurse provide? Restrict protein intake as ordered. Increase intake of potassium-rich foods. Follow a low-calcium diet. Encourage intake of food containing oxalates.

Avoid working while bent over the computer. (The patient should avoid working while bent over because this position presses on the diaphragm, causing discomfort.The patient with GERD needs to eat four to six meals a day. The head of the patient's bed would be elevated approximately 6 inches (15 cm). Both tea and coffee need to be eliminated from this patient's diet because of the caffeine content.)

The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a patient's gastroesophageal reflux disease (GERD). Which change does the nurse recommend to this patient? Eat only two or three meals daily. Sleep flat in a left side-lying position. Drink tea instead of coffee. Avoid working while bent over the computer.

Misoprostol (Cytotec) (The nurse expects that the primary health care provider will request that Misoprostol be given to the patient. Misoprostol is a prostaglandin analogue that protects against nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers.Bismuth subsalicylate is an antidiarrheal drug that contains salicylates, which can cause bleeding and would be avoided in patients who have PUD. Magnesium hydroxide is an antacid that may be used to neutralize stomach secretions but is not used specifically to help prevent NSAID-induced ulcers. Metronidazole is an antimicrobial agent used to treat Helicobacter pylori infection.)

The nurse reviews a medication history for a patient newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the primary health care provider will request which medication for this patient? Bismuth subsalicylate (Pepto-Bismol) Magnesium hydroxide (Maalox) Metronidazole (Flagyl) Misoprostol (Cytotec)

Obese female receiving hormone replacement therapy (The client at highest risk is the obese female receiving hormone replacement therapy. Both obesity and hormone replacement therapy have been found to increase a woman's risk for developing gallstones. Other risk factors for developing gallstones are type 2 diabetes, dyslipidemia, and insulin resistance.Men are at lower risk than women for developing gallstones. Although pregnancy increases the risk for a woman to develop gallstones, a woman's thin frame lessens that risk.)

The nurse suspects that which client is at highest risk for developing gallstones? Obese male with chronic obstructive pulmonary disease Obese female receiving hormone replacement therapy Thin male with a history of coronary artery bypass grafting Thin female who has recently given birth

drinking 2000 to 3000 mL of fluid a day. (A fluid intake of 2000 to 3000 mL daily is recommended to help flush out minerals before stones can form. Avoidance of calcium is not usually recommended for patients with renal calculi. Coffee tends to increase stone recurrence. There is no need for a patient to strain all urine routinely after a stone has passed, and this will not prevent stones.)

The nurse teaches a 64-year-old woman to prevent the recurrence of renal calculi by using a filter to strain all urine. avoiding dietary sources of calcium. choosing diuretic fluids such as coffee. drinking 2000 to 3000 mL of fluid a day.

proton pump inhibitors. (Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.)

The nurse will anticipate teaching a patient experiencing frequent heartburn about a barium swallow. radionuclide tests. endoscopy procedures. proton pump inhibitors.

Drink fluids between meals but not with meals. (Intake of fluids with meals tends to cause dumping syndrome and diarrhea. Food choices should be low in fat and fiber. Exercise does not prevent the development of flabby skin.)

The nurse will be teaching self-management to patients after gastric bypass surgery. Which information will the nurse plan to include? Drink fluids between meals but not with meals. Choose high-fat foods for at least 30% of intake. Developing flabby skin can be prevented by exercise. Choose foods high in fiber to promote bowel function.

Constipation (Aluminum- and calcium-containing antacids cause constipation, magnesium-containing antacids cause diarrhea, and sodium-containing antacids cause sodium and fluid retention.)

The nurse will monitor a client taking an aluminum-containing antacid, such as aluminum hydroxide (Amphojel), for which adverse effect? Constipation Gastrointestinal (GI) upset Fluid retention Diarrhea

Neutralizes gastric acid (Antacids work by neutralizing gastric acid, which would cause an increase in pH. They do not affect gastric motility.)

The nurse will teach clients that antacids are effective in the treatment of hyperacidity based on which mechanism of action? Neutralizes gastric acid Decreases gastric pH Decreases stomach motility Decreases duodenal pH

Intravenous pyelogram (Flank pain and calcium phosphate crystals are associated with renal calculi. An intravenous pyelogram allows the provider to observe pathological problems such as obstruction of the ureter. A renal ultrasound is performed to identify gross structures. A bladder scan measures the amount of urine in the bladder. A KUB x-ray shows size, shape, symmetry, and location of the kidneys.)

The nurse would anticipate an order for which diagnostic test for a patient who has severe flank pain and calcium phosphate crystals revealed on urinalysis? Renal ultrasound Bladder scan KUB x-ray Intravenous pyelogram

Assess the client's airway. (Obese clients are at higher risk for hypoventilation. The arterial blood gas values indicate acute respiratory acidosis with hypoxia. The client needs oxygen. However, if the airway is not patent, increasing the oxygen flow rate will be of minimal benefit. The first action is to ensure a patent airway and then apply oxygen, notify the physician, and document events. The client may need to be re-intubated and mechanically ventilated. Checking the client's oxygen saturation level will provide no additional information about the client's oxygenation status.)

The postanesthesia care nurse is caring for a client who had gastric banding surgery and was extubated an hour ago. The client's blood gases are as follows: pH, 7.22; HCO₃⁻ 21 mEq/L; PCO₂, 65 mm Hg; and PO₂, 58 mm Hg. Which is the priority action by the nurse? Assess the client's airway. Increase the client's oxygen flow rate. Check the client's oxygen saturation level. Document findings in the client's chart.

b. cholelithiasis. (Cholelithiasis refers to the presence of gallstones in the gallbladder. When continued infection alters the solubility of the bile ingredients, cholesterol separates out and forms gallstones.)

The presence of gallstones in the gallbladder is called a. cholecystitis. b. cholelithiasis. c. cholecystectomy. d. cholecystokinin.

Antibiotic-associated diarrhea (Normal intestinal flora inhibit the growth of Clostridium difficile. When broad-spectrum antibiotics, especially third-generation cephalosporins, are administered, normal flora is altered and C. difficile can proliferate and release toxins that cause antibiotic-associated diarrhea.)

The proliferation of Clostridium difficile causes Antibiotic-associated diarrhea Escherichia coli diarrhea Urinary Clostridium infection Anal yeast infection

b. Poor body image (Common emotional consequences of obesity include poor body image, low self- esteem, social isolation, and feelings of depression and isolation.)

The psychologic effects of being obese during adolescence include which of the following? a. Sexual promiscuity b. Poor body image c. Feelings of contempt for thin peers d. Accurate body image but self-deprecating attitude

Ask about bowel movements. (Constipation is a common side effect of lorcaserin. The other assessments would be appropriate for other weight-loss medications.)

To evaluate an obese patient for adverse effects of lorcaserin (Belviq), which action will the nurse take? Take the apical pulse rate. Check sclera for jaundice. Ask about bowel movements. Assess for agitation or restlessness.

sardines and liver. (Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.)

To prevent recurrence of uric acid renal calculi, the nurse teaches the patient to avoid eating milk and cheese. sardines and liver. legumes and dried fruit. spinach, chocolate, and tea.

b. Secondary prevention (Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.)

Using a behavioral health risk survey and identifying the factors leading to obesity in the family is an example of which level of prevention? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

a. Dumping syndrome c. Addison disease d. Prolonged muscular exercise (Dumping syndrome, Addison disease, and prolonged exercise are functional causes of hypoglycemia. Overdose of insulin and chronic alcoholism are exogenous causes.)

What are functional causes of hypoglycemia? (Select all that apply.) a. Dumping syndrome b. Overdose of insulin c. Addison disease d. Prolonged muscular exercise e. Chronic alcoholism

c. Inflatable penile implants (Penile implants may be prescribed for patients with the inability to initiate, fill, or restore an erection.)

What can men who have sustained spinal cord injuries with resultant ED use to aid in the ability to have sexual intercourse? a. Testosterone injections b. Papaverine penile injections c. Inflatable penile implants d. Oral sildenafil (Viagra)

Metabolic alkalosis (Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum potassium and serum calcium would decrease, not increase, with alkalosis.)

What condition will the nurse monitor for with a client using sodium bicarbonate to treat gastric hyperacidity? Hypercalcemia Hyperkalemia Metabolic acidosis Metabolic alkalosis

Low carbohydrate diets lead to rapid weight loss but are difficult to maintain. (The restrictive nature of fad diets makes the weight loss achieved by the patient more difficult to maintain. Portion size can be estimated in other ways besides weighing. Severely calorie-restricted diets are not necessary for patients in the overweight category of obesity and need to be closely supervised. Patients should weigh weekly rather than daily.)

What information will the nurse include for an overweight 35-year-old woman who is starting a weight-loss plan? Weigh yourself at the same time every morning and evening. Stick to a 600- to 800-calorie diet for the most rapid weight loss. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain. Weighing all foods on a scale is necessary to choose appropriate portion sizes.

It competes with histamine for binding sites on the parietal cells. (Histamine receptor-blocking drugs decrease gastric acid by competing with histamine for binding sites on the parietal cells.)

What is the mechanism of action for Famotidine (Pepcid)? It forms a protective coating against gastric acid, pepsin, and bile salts. It competes with histamine for binding sites on the parietal cells. It irreversibly binds to the hydrogen-potassium-adenosine triphosphatase (ATPase) pump. It causes a decrease in stomach pH, reducing stomach acidity.

b. Decreased libido (Side effects of drugs used for BPH also include erectile dysfunction, decreased seminal fluid, and reduced fertility. The most common side effect of these drugs is a decreased interest in sexual activity.)

What is the most common side effect of drugs used for benign prostate hypertrophy (BPH)? a. Low blood pressure b. Decreased libido c. Light-headedness d. Hair loss

Rest in a sitting position for one hour (Gravity facilitates digestion and prevents reflux of stomach contents into the esophagus. Water should not be taken with or immediately after meals because it overdistends the stomach. Exercise immediately after eating may prolong the digestive process. Lying down immediately after eating facilitates reflux of the stomach contents into the esophagus.)

What should the nurse teach the client with gastroesophageal reflux disease to do after meals? Drink 8 ounces (240 mL) of water Take a walk for 30 minutes Lie down for at least 20 minutes Rest in a sitting position for one hour

Dizziness or confusion (During use of this drug, metronidazole administered intravenously, report to the health care provider any changes in neurologic status (e.g., dizziness, confusion).)

When a client is receiving an IV infusion of metronidazole (Flagyl), what adverse effect would the nurse immediately report to the health care provider? Elevated blood pressure Dark colored urine Diminished breath sounds Dizziness or confusion

d. Uses positive pressure to keep the airway open (The sleep apnea mask, through positive pressure, keeps the airway open during sleep.)

When a patient with sleep apnea says, "I'm not wearing that silly mask. I look like something out of Star Wars," what should the nurse remind the patient about the function of the mask? a. Increases oxygen intake b. Stimulates regular respirations c. Sounds an alarm when the oxygen concentration drops d. Uses positive pressure to keep the airway open

Assist a patient to place the CPAP device correctly over the nose and mouth at bedtime. (Because CPAP mask placement is consistently done in the same way, this is appropriate to delegate to UAP. The other actions require critical thinking and nursing judgment, and should be done by the RN.)

When caring for patients with sleep disorders, which activity can the nurse appropriately delegate to unlicensed assistive personnel (UAP)? Interview a new patient about risk factors for obstructive sleep disorders. Discuss the benefits of oral appliances in decreasing obstructive sleep apnea. Help a patient choose an appropriate continuous positive airway pressure (CPAP) mask. Assist a patient to place the CPAP device correctly over the nose and mouth at bedtime.

c. Decreased weight (Orlistat (Xenical) is a nonstimulant drug that is used as part of a weight loss program. The other options are incorrect.)

When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect? a. Increased wakefulness b. Increased appetite c. Decreased weight d. Decreased hyperactivity

30 to 60 (Infuse IV doses of metronidazole as prescribed and generally are to infuse over 30 to 60 minutes and never as an IV bolus.)

When preparing to administer an intravenous (IV) infusion of metronidazole (Flagyl), the nurse will anticipate infusing the medication over how many minutes? 30 to 60 5 to 10 15 to 30 1 to 5

b. Renal failure (Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.)

When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium need to be used cautiously in patients with which condition? a. Peptic ulcer disease b. Renal failure c. Hypertension d. Heart failure

Place the patient in a private room on contact isolation. (Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not cause C. difficile.)

Which action will the nurse include in the plan of care for a 42-year-old patient who is being admitted with Clostridium difficile? Educate the patient about proper food storage. Order a diet with no dairy products for the patient. Place the patient in a private room on contact isolation. Teach the patient about why antibiotics will not be used.

Man with a 42 in waist and 44 in hips (The waist-to-hip ratio for this patient is 0.95, which exceeds the recommended level of <0.80. A patient with a BMI of 18 kg/m² is considered underweight. A BMI of 24 kg/m² is normal. Health risks associated with obesity increase in women with a waist circumference larger than 35 in (89 cm) and men with a waist circumference larger than 40 in (102 cm).)

Which adult will the nurse plan to teach about risks associated with obesity? Man who has a BMI of 18 kg/m² Man with a 42 in waist and 44 in hips Woman who has a body mass index (BMI) of 24 kg/m² Woman with a waist circumference of 34 inches (86 cm)

Permanent discoloration of the teeth (Tetracycline is contraindicated in children younger than 8 years of age because it can cause permanent discoloration of the adult teeth and tooth enamel, which are still forming in the child.)

Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? Delayed growth development Drug-induced neurotoxicity Permanent discoloration of the teeth Gastrointestinal (GI) and rectal bleeding

Check the patient's blood pressure. (Elevated blood pressure is one of the characteristics of metabolic syndrome. The other information also may be obtained by the nurse, but it will not assist with the diagnosis of metabolic syndrome.)

Which assessment action will help the nurse determine if an obese patient has metabolic syndrome? Take the patient's apical pulse. Check the patient's blood pressure. Ask the patient about dietary intake. Dipstick the patient's urine for protein.

Middle-aged man who has had diabetes mellitus for 25 years (Organic erectile dysfunction occurs as a gradual reduction in sexual functioning. Diabetes mellitus causes microvascular and macrovascular complications that decrease the sensation and autonomic nerve activity required for achievement of an erection. The other factors will not increase the client's risk for development of organic erectile dysfunction.)

Which client is most likely to have organic erectile dysfunction? Middle-aged man who first had sexual intercourse at age 15 Middle-aged man who has had diabetes mellitus for 25 years Young man who had a myocardial infarction 2 years ago Young man who has a job that causes him high stress levels

"Smoking decreases the effects of this medication, so I should look into cessation programs." (Clients taking histamine₂-receptor-blocking drugs should avoid spicy foods, extremes in temperatures, alcohol, and smoking. Diarrhea, not constipation, is a GI adverse effect. Whereas cimetidine should be taken with meals, famotidine can be taken without regard to meals.)

Which client statement demonstrates understanding of teaching by the nurse regarding the use of histamine₂-receptor antagonists? "Because I am taking this medication, it is OK for me to eat spicy foods." "Smoking decreases the effects of this medication, so I should look into cessation programs." "I should take this medication 1 hour after each meal to maximally decrease gastric acidity." "I should increase bulk and fluids in my diet to prevent constipation."

a. Heredity is an important factor in the development of obesity. (Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors.)

Which of the following statements is correct about childhood obesity? a. Heredity is an important factor in the development of obesity. b. Childhood obesity in the United States is decreasing. c. Childhood obesity is the result of inactivity. d. Childhood obesity can be attributed to an underlying disease in most cases.

Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall (An increased WBC count, calcified gallstones visualized on the abdominal X-ray, and edema of the gallbladder wall are the best diagnostic results to indicate gallbladder disease. Acute cholecystitis is seen as edema of the gallbladder wall and pericholecystic fluid. Ultrasonography of the right upper quadrant is the best diagnostic test for cholecystitis.An increased WBC count, not decreased, is evidence of inflammation. Only calcified gallstones, not noncalcified gallstones, will be visualized on abdominal X-ray. Alkaline phosphatase will be elevated if liver function is abnormal; this is not common in gallbladder disease.)

Which diagnostic results lead the nurse to suspect that a client may have gallbladder disease? Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall Decreased WBC count, visualization of calcified gallstones, increased alkaline phosphatase Increased WBC count, visualization of noncalcified gallstones, edema of the gallbladder wall Decreased WBC count, visualization of noncalcified gallstones, increased alkaline phosphatase

The patient is pale and has many bruises. (Because orlistat blocks the absorption of fat-soluble vitamins, the patient may not be receiving an adequate amount of vitamin K, resulting in a decrease in clotting factors. Abdominal bloating and liquid stools are common side effects of orlistat and indicate that the nurse should remind the patient that fat in the diet may increase these side effects. Weight loss plateaus are normal during weight reduction.)

Which finding for a patient who has been taking orlistat (Xenical) is most important to report to the health care provider? The patient frequently has liquid stools. The patient is pale and has many bruises. The patient complains of bloating after meals. The patient is experiencing a weight loss plateau.

41-year-old librarian who has a body mass index (BMI) of 42 kg/m² says that the spouse complains about snoring (The patient's BMI and snoring suggest possible sleep apnea, which can cause complications such as cardiac dysrhythmias, hypertension, and right-sided heart failure. Melatonin is safe to use as a therapy for jet lag. Short-term use of diphenhydramine in young adults is not a concern. Hot chocolate contains only 5 mg of caffeine and is unlikely to affect this patient's sleep quality.)

Which information regarding a patient's sleep is most important for the nurse to communicate to the health care provider? 64-year-old nurse who works the night shift reports drinking hot chocolate before going to bed in the morning 21-year-old student who takes melatonin to assist in sleeping when traveling from the United States to Europe 41-year-old librarian who has a body mass index (BMI) of 42 kg/m² says that the spouse complains about snoring 32-year-old accountant who is experiencing a stressful week uses diphenhydramine (Benadryl) for several nights

Sucralfate should be taken on an empty stomach one hour before meals. (Sucralfate works best in a low pH environment; therefore it should be given on an empty stomach either one hour before or two hours after meals. Sucralfate also should be administered no sooner than 30 minutes before or after an antacid. The acid-neutralizing effects of antacids last approximately 30 minutes when taken on an empty stomach and 3 to 4 hours when taken after meals. When sucralfate and an antacid are both prescribed, they are each most effective when the sucralfate is scheduled an hour before meals and the antacid is scheduled after meals. Sucralfate is prescribed for the short-term treatment of peptic ulcers. Its use is limited to 4 to 8 weeks. The client should follow the recommendations of the primary health care provider with regard to antacid selection. Sodium bicarbonate can produce acid-base imbalances which could be harmful, especially in elderly clients.)

Which information should be included in the teaching plan for the elderly client with peptic ulcer disease who is taking an antacid and sucralfate? Antacids should be taken 30 minutes before a meal. Sucralfate should be taken on an empty stomach one hour before meals. Sucralfate is prescribed for the long-term maintenance of peptic ulcer disease. Sodium bicarbonate is an inexpensive over-the-counter antacid with few adverse effects.

"Apply sunscreen or wear protective clothing when outdoors." (Photosensitivity is a common adverse effect of doxycycline, a tetracycline antibiotic. The client should avoid direct sun exposure and tanning bed use while taking this medication. Exposure to the sun can cause severe burns.)

Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)? "Take the medication with milk to minimize gastrointestinal upset." "Apply sunscreen or wear protective clothing when outdoors." "Take the medication until you have no fever and feel better." "Keep the remainder of the medication in case of recurrence."

"Keep the head of your bed elevated on blocks." (Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.)

Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? "Peppermint tea may reduce your symptoms." "Keep the head of your bed elevated on blocks." "You should avoid eating between meals to reduce acid secretion." "Vigorous physical activities may increase the incidence of reflux."

Instructing the patient on coughing and breathing techniques (Coughing and deep breathing can prevent major postoperative complications such as carbon monoxide retention and hypoxemia. Information about passive range of motion, the NG tube, and postoperative modifications in lifestyle will also be discussed, but avoidance of respiratory complications is the priority goal after surgery.)

Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass? Educating the patient about the nasogastric (NG) tube Instructing the patient on coughing and breathing techniques Discussing necessary postoperative modifications in lifestyle Demonstrating passive range-of-motion exercises for the legs

Respiratory status (In obstructive sleep apnea, the upper airway becomes partially or completely blocked, diminishing airflow and stopping it. The person still attempts to breathe because the chest and abdominal movement continue, which results in loud snoring and snorting sounds. According to the ABCs of prioritizing care, airway and respiratory status take priority.)

Which of the following would be most important for the nurse to monitor in a patient who has obstructive sleep apnea? Gastrointestinal function Circulatory status Respiratory status Neurological function

"Drink plenty of water." "Substitute lemon juice for tea." (Renal calculi is the formation of kidney stones. Drinking plenty of water will keep the body hydrated and prevent further formation of stones. Tea contains caffeine, a diuretic, which causes dehydration. Therefore the client must be advised to replace tea with lemon juice. Spinach is rich in oxalates. Consuming spinach soup may aggravate the problem, due to the formation of oxalate crystals. Excessive consumption of proteins may precipitate uric acid stones. Therefore the use of proteins should not be encouraged. Foods rich in omega-3-fatty acids are beneficial in maintaining good health. However, the use of omega-3-fatty acids, specifically in the treatment, mitigation, or prevention of kidney stones, is not justified.)

Which instructions given to a client with renal calculi would be most beneficial? Select all that apply. "Drink plenty of water." "Have spinach soup every day." "Substitute lemon juice for tea." "Include high amounts of protein in the diet." "Consume foods rich in omega-3-fatty acids."

Limit dietary intake of fat. (Orlistat is an anorexiant that works by blocking the absorption of fat from the GI tract. Restricting dietary intake of fat reduces the GI adverse effects associated with increased fat content in stool (flatulence, oily spotting, and fecal incontinence).)

Which instructions should the nurse discuss to reduce the gastrointestinal (GI) adverse effects of orlistat (Xenical)? Advise to take vitamin C supplement. Take the medication with an antacid. Limit dietary intake of fat. Increase fluid and fiber in the diet.

Place the client in a side-lying position (Recall the airway, breathing, and circulation (ABCs) of priority care. The client who needs assistance to manage self-care (dependent) should be placed in the side-lying position when vomiting to prevent aspiration. The use of supplemental oxygen may support oxygen saturation in the client with decreased hemoglobin because of gastrointestinal bleeding. However, in the dependent client who is vomiting, applying oxygen is of lower priority than placing the client in a side-lying position. The nurse should anticipate a prescription for packed red blood cells in the client with a significant gastrointestinal bleed. Restoring circulation, however, is of lower priority than protecting the airway in a dependent client whose airway is at risk. The immediate physical examination of the client with active gastrointestinal bleeding includes evaluation of vital signs as a means of assessing for shock. Assessing for adequate circulation does not take priority over protecting the airway.)

Which is the priority intervention for the dependent client with peptic ulcer disease (PUD) who is vomiting bright red blood? Apply oxygen Place the client in a side-lying position Prepare to administer packed red blood cells Assess the client's pulse and blood pressure

A 34-year-old woman experiencing mental confusion (The least likely candidate is the client who is experiencing mental confusion. This client may have difficulty complying with the postoperative treatment regimen.The client with hypertension, the client with sleep apnea, and the client with diabetes are all candidates for bariatric surgery despite having these complications.)

Which morbidly obese client is the least likely candidate for bariatric surgery? A 34-year-old woman experiencing mental confusion A 44-year-old man with a history of hypertension A 50-year-old woman with a history of sleep apnea A 52-year-old man with a history of type 1 diabetes mellitus

Asking the adults about situations that tend to increase appetite (Behavior modification programs focus on how and when the person eats and de-emphasize aspects such as calorie counting. Nonfood rewards are recommended for achievement of weight-loss goals. Patients are often taught to restrict eating to designated meals when using behavior modification.)

Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program? Having the adults write down the caloric intake of each meal Asking the adults about situations that tend to increase appetite Suggesting that the adults plan rewards, such as sugarless candy, for achieving their goals Encouraging the adults to eat small amounts frequently rather than having scheduled meals

Administer prescribed analgesics. (Although all of the nursing actions may be used for patients with renal lithiasis, the patient's presentation indicates that management of pain is the highest priority action. If the patient has urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of infection or nausea.)

Which nursing action is of highest priority for a 68-year-old patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain? Administer prescribed analgesics. Monitor temperature every 4 hours. Encourage increased oral fluid intake. Give antiemetics as needed for nausea.

Risk for injury related to thrombocytopenia (A serious side effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding. The patient receiving famotidine may experience hypotension as an adverse effect, not hypertension. Famotidine does not cause immunosuppression or urinary retention.)

Which nursing diagnosis is appropriate for a patient receiving famotidine (Pepcid)? Ineffective peripheral tissue perfusion related to hypertension Risk for infection related to immunosuppression Impaired urinary elimination related to retention Risk for injury related to thrombocytopenia

A 58-year-old woman diagnosed with chronic depression (Many think OSA affects middle-age men more frequently, particularly when they are obese. However, obstructive sleep apnea is also common in postmenopausal women, younger women, and children. Although the clients in all of the options may experience OSA, the postmenopausal woman has the greatest risk.)

Which of the following clients experiencing disrupted sleep patterns is most at risk for obstructive sleep apnea (OSA)? A 15-year-old boy with type 1 diabetes A 22-year-old diagnosed with Crohn's disease A 49-year-old man who is an avid cross-county runner A 58-year-old woman diagnosed with chronic depression

Excessive snoring (Partners of clients with sleep apnea often complain that the client's snoring disturbs their sleep. Restlessness is not most associated with sleep apnea. Sleeptalking is associated with sleep-wake transition disorders, not sleep apnea. Somnambulism is associated with parasomnias (specifically arousal disorders and sleep-wake transition disorders).)

Which of the following information provided by the client's bed partner is most associated with sleep apnea? Restlessness Talking during sleep Somnambulism Excessive snoring

Sleep apnea (Sleep apnea refers to recurrent periods of absence of breathing for 10 seconds or longer, occurring at least five times per hour.)

Which of the following problems is associated with obesity, heavy snoring, and shallow breathing? Sleep apnea Narcolepsy Hypersomnia Hyperpnea

d. Patient is able to describe measures to prevent recurrence of calculi. (Recurrence of renal calculi is common. The patient needs to possess the information necessary to understand the formation of stones to reduce the risk of their recurrence.)

Which outcome is most necessary for a patient diagnosed with renal calculi? a. Patient states an awareness of signs and symptoms of kidney stones and knows where to find pain relief. b. Patient will measure intake and output so that they will be approximately equal. c. Patient will avoid infections and situations that would increase stress. d. Patient is able to describe measures to prevent recurrence of calculi.

Cherry gelatin with fruit (Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.)

Which patient choice for a snack 2 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? Chocolate pudding Glass of low-fat milk Cherry gelatin with fruit Peanut butter and jelly sandwich

Wear gloves when contact with body secretions or body fluids is expected. (The nurse must wear gloves and wash hands before and after potential exposure to the client's body secretions or fluids. C. difficile infection requires contact precautions. Hands must be properly washed before and after any contact with the client with C. difficile infection. Alcohol-based hand rubs are not effective for hand hygiene in the care of clients with C. difficile.Hands must be washed even if not visibly soiled. It is not necessary to wear a mask when caring for clients with C. difficile infection. A mask and eye protection are not necessary to prevent transmission of C. difficile.)

Which precaution is best for the nurse to take to prevent the transmission of Clostridium difficile infection? Carefully wash hands that are visibly soiled. Wear a mask and gloves when the client's body secretions or body fluids are likely to be handled. Wear a mask with eye protection and perform proper handwashing. Wear gloves when contact with body secretions or body fluids is expected.

d. "Avoid driving until you know how this drug affects you." (Older adults are more likely to experience drowsiness and acute confusion when taking these drugs. They should avoid driving or operating dangerous equipment until they know how the drug affects them. Although the drug should be taken with a meal or before bedtime, the safety issue with the confusion and drowsiness has the highest priority. Avoiding caffeine and elevating the head of the bed are helpful for GERD but are not related to drug therapy.)

Which precaution is most important for the nurse to teach an older patient who is starting histamine H₂ blockers for gastroesophageal reflux disease (GERD)? a. "Do not drink caffeine while taking this drug." b. "Elevate the head of your bed by 6 to 10 inches." c. "Take this drug with meals and before going to bed." d. "Avoid driving until you know how this drug affects you."

3.7 g/dL (37 g/L) (The normal serum albumin level for men and women is 3.5 to 5.0 g/dL (35 to 50 g/L).The other options given are incorrect.)

Which serum albumin level does the nurse expect to see in a healthy, ambulatory adult client? 2.3 g/dL (23 g/L) 3.7 g/dL (37 g/L) 5.1 g/dL (51 g/L) 5.8 g/dL (58 g/L)

Antibiotics have been given to clients for conditions that do not require antibiotics. (Antibiotics have often been prescribed for conditions that do not require them, or have been given at higher doses or for longer periods of time than needed. As a result, a number of microorganisms have become resistant to certain antibiotics.Microorganisms are more resistant to certain antibiotics. Strictly adhered-to Standard Precautions are adequate to prevent infection. Most antibiotics are not effective for every infection.)

Which statement about why multidrug-resistant organisms and other infections are increasing in incidence is correct? Antibiotics have been given to clients for conditions that do not require antibiotics. Microorganisms are more susceptible to antibiotics today than when they were given years ago. Additional precautions are taken, along with Standard Precautions, to prevent infection. Most antibiotics are effective for infection.

"You are likely to notice changes in how you feel with just a few weeks of diet and exercise." (Motivation is a key factor in successful weight loss and a short-term outcome provides a higher motivation. A 22-year-old patient is unlikely to be motivated by future health problems. Telling a patient that the initial weight loss is water will be discouraging, although this may be correct. Changing lifestyle habits is necessary, but this process occurs over time and discussing this is not likely to motivate the patient.)

Which statement by the nurse is most likely to help a morbidly obese 22-year-old man in losing weight on a 1000-calorie diet? "It will be necessary to change lifestyle habits permanently to maintain weight loss." "You will decrease your risk for future health problems such as diabetes by losing weight now." "You are likely to notice changes in how you feel with just a few weeks of diet and exercise." "Most of the weight that you lose during the first weeks of dieting is water weight rather than fat."

"As soon as I get home, I'm going to enjoy a nice bowl of fruit." (After gastric bypass surgery, clients are limited to fluids and pureed foods for about 6 weeks. Then the client can progress to a more normal diet. Eating fruit right after discharge would not be recommended. The other statements indicate good understanding.)

Which statement indicates that the client needs additional discharge teaching after gastric bypass surgery? "I hope my type 2 diabetes is cured and I won't need insulin anymore." "As soon as I get home, I'm going to enjoy a nice bowl of fruit." "If I get nauseated, I know I'm eating too much at one time." "I will be sure to report any back, shoulder, or abdominal pain."

"I will remain upright for several hours after each meal." (Clients with hiatal hernia experience gastroesophageal reflux disease (GERD). Positioning is an important intervention. The client should be taught to sleep with the head of the bed elevated, to remain upright after meals for 2 to 3 hours, and to avoid straining or restrictive clothing. The other actions are not consistent with managing a sliding hiatal hernia.)

Which statement indicates that the client understands the management of his or her sliding hiatal hernia? "I will lie flat for 30 minutes after each meal." "I will remain upright for several hours after each meal." "I will have my blood count done in 2 weeks to check for anemia." "I will sleep at night while lying on my left side to prevent reflux."

Dehiscence (Dehiscence is the separation and disruption of previously joined wound edges; this condition typically occurs in obese clients. Adhesions are bands of scar tissue that form between or around organs. Evisceration occurs when wound edges separate to the extent that intestines protrude through the wound. Contractions are a normal part of healing, but excessive contractions result in deformity.)

While caring for an obese client who underwent a cholecystectomy, the nurse notices a separation in the surgical incision. Which complication does the nurse identify? Adhesions Dehiscence Evisceration Contractions

sildenafil (viagra)

medication: ED tx PDE5 inhibitor (PO) ↑ blood flow to corpus cavernosum contra: nitrate use ADR: h/a, dyspepsia, flushing, MYOCARDIAL INFARCTION, SUDDEN DEATH take 30 min-4 hr before sexual activity

tadalafil (cialis)

medication: ED tx PDE5 inhibitor (PO) ↑ blood flow to corpus cavernosum contra: nitrate use ADR: h/a, flushing take at least 30 min before sexual activity

avanafil (stendra)

medication: ED tx PDE5 inhibitor (PO) ↑ blood flow to corpus cavernosum contra: nitrate use ADR: h/a, flushing, take 15 min before sexual activity

vardenafil (levitra)

medication: ED tx PDE5 inhibitor (PO) ↑ blood flow to corpus cavernosum contra: nitrate use ADR: h/a, flushing, HEARING LOSS, VISION LOSS take 30 min-4 hr before sexual activity

lorcaserin (belviq)

medication: ↓ wt anorexigenic (PO) appetite suppressant, creates sense of fullness ADR: h/a, dizziness, dry mouth, constipation monitor for SI, serotonin syndrome, LOC △

liraglutide (saxenda)

medication: ↓ wt antidiabetic (IM) activates appetite regulation contra: insulin use ADR: thyroid carcinoma, ↓ BG, renal impairment, SI, acute pancreatitis

orlistat (xenical)

medication: ↓ wt lipase inhibitor (PO) triglyceride hydrolysis ADR: loose stool, gas, fecal urgency, cramping, nausea reduce fat intake to <30% of diet to avoid GI problems

naltrexone HCl/bupropion HCl (contrave)

medication: ↓ wt opioid antagonist, antidepressant appetite suppressant contra: uncontrolled htn, seizures ADR: SI, neuropsychiatric reactions

phentermine/topiramate (qsymia)

medication: ↓ wt sympathomimetic, anticonvulsant (PO) appetite suppressant ADR: tachycardia, paresthesias, insomnia, dizziness, dry mouth, constipation, SI monitor for SI

diethylpropion HCl phendimetrazone tartrate phentermine HCl

medication: ↓ wt (3) sympathomimetic appetite suppressant contra: hyperthyroid, glaucoma, drug abuse hx, MAOIs ADR: palpitations, restlessness, insomnia, dry mouth, diarrhea, constipation, libido △

In the ureteropelvic junction (The three narrowed areas of each ureter are the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovescial junction. These three areas of the ureters have a propensity for obstruction by renal calculi or stricture. Obstruction of the ureteropelvic junction is most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction. The urethra is not part of the ureter.)

nurse knows that specific areas in the ureters have a propensity for obstruction. Prompt management of renal calculi is most important when the stone is located where? In the ureteropelvic junction In the ureteral segment near the sacroiliac junction In the ureterovesical junction In the urethra

a. Antibiotic (The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole, plus the antibiotics clarithromycin and either amoxicillin or metronidazole, or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used.)

patient will be taking a 2-week course of combination therapy with omeprazole (Prilosec) and another drug for a peptic ulcer caused by Helicobacter pylori. The nurse expects a drug from which class to be ordered with the omeprazole? a. Antibiotic b. Nonsteroidal anti-inflammatory drug c. Antacid d. Antiemetic