exam 2

which test is done to determine if SOB is due to heart failure?

B-type natriuretic peptide (BNP)

a nurse is teaching a client who has a hiatal hernia. which of the following client statements indicates an understanding of the teaching? - "I can take my medications with soda" - "Peppermint tea will increase my indigestion" - "wearing an abdominal binder will limit my symptoms" - "I will drink hot chocolate at bedtime to help me sleep better" - "I can lift weights as a way to exercise"

"Peppermint tea will increase my indigestion"

a nurse is completing discharge teaching to a client who is postoperative following fundoplication. which of the following statements by the client indicates understanding of the teaching? - "when sitting in my lounge chair after a meal, i will lower the back of it" - "i will try to eat three large meals a day" - "i will elevate the head of my bed on blocks" - "when sleeping, i will lay on my left side"

"i will elevate the head of my bed on blocks"

a nurse is contemplating discharge teaching for a client who has an infection due to H. pylori. which of the following statements by the client indicates understanding of the teaching? - "i will continue my prescriptions for corticosteroids" - "i will schedule a CT scan to monitor improvement" - "i will take a combination of medications for treatment" - "i will have my throat swabbed to recheck for this bacteria"

"i will take a combination of medications for treatment"

a nurse is providing discharge teaching for a client who has heart failure and is on a fluid restriction of 2,000 mL/day. the client asks the nurse how to determine the appropriate amount of fluids he is allowed. which of the following statements is an appropriate response by the nurse? - "pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink" - "each glass contains 8 oz. there are 30 mL per oz, so you can have a total of 8 glasses or cups of fluid each day" - "this is the same as 2 qt, or about the same as two pots of coffee" - "take sips of water or ice chips so you will not take in too much fluid"

"pour the amount of fluid you drink into an empty 2-liter bottle to keep track of how much you drink"

what to expect for plan of care for patient with GERD, diagnosed with Barrett's esophagus?

- AKA esophageal metaplasia - Periodic endoscopy - Treatment of GERD with medication - Lifestyle changes - Antireflux surgery

patient with IBS with more frequent symptoms - identify lifestyle changes and triggers

- Avoid foods that trigger such as dairy, wheat, corn, fried foods, alcohol, spicy foods, and apartame, and other foods containing fructose and sorbitol - Lifestyle: stress-management (for stress-induced), **food diary (to identify triggers), increase dietary fiber intake

health promotion education for esophageal reflux

- Maintain a weight below BMI of 30 - Stop smoking - Limit or avoid alcohol and tobacco use - Eat a low-fat diet - Avoid foods that lower LES pressure - Avoid eating or drinking 2 hours before bed - Avoid tight-fitting clothing - Elevate head of bed 6 to 8 inches

what type of questions with the nurse ask to help determine IBS?

- Rome III criteria questions - Requires the presence of abdominal pain and/or discomfort at least 3 months that is associated with two or more of the following: Improvement w/ defecation, Change in stool frequency at onset, Change in the stool appearance at onset

explaining Prilosec to a patient with heartburn. Medication is described as?

- available as prescription and OTC - proton pump inhibitor class - must be taken 30 minutes before first meal of the day - most common side effect = headaches - long-term use or high doses may increase the risk of fractures of the hip, wrist, and spine - associated with increased risk of C.diff infection in hospitalized patients

discharge teaching for patient with heart failure

- dietary therapy: consult pt about restricted food, weigh self at same time everyday, restrict fluid intake. - activity program: increase activity gradually, avoid extreme heat and cold. - ongoing monitoring: know signs and symptoms of worsening HF; report alarming changed to HCP such as breathlessness, swelling, frequent dry cough, dizziness, fainting, - health promotion: vaccines up to date, develop a plan to reduce risk factors - rest - drug therapy

client with peptic ulcer disease (PUD) on Flagyl - important health education

- do not drink alcohol when taking; can cause sweating, N&V, tachycardia, hypotension - taking with meals may help with expected side effects of abdominal discomfort or nausea

what patient is assessed first after change of shift report?

- emergency first, ABCD (airway, breathing, circulation, disability) - respond to trends v. isolated findings - actual before potential - systemic before local - acute before chronic

C.diff - action to include in plan of care?

- ensure surfaces and equipment are disinfected with 10 % bleach solution or disinfectant labeled as C. difficile sporicidal - treatment: first line Metronidazole (Flagyl) followed by Vancomycin - fecal microbiota transplantation

what to document when patient says "i feel like i'm suffocating"?

- exact words of patient - dyspnea - possible dx = left-sided heart failure

what to teach client with heart failure to do fluid balance assessment in the home setting?

- helping patients deal with thirst as a side effect of the drugs is important. to deal with the thirst, suggest ice chips, gum, hard candy, or ice pops - tell patients to weigh themselves daily as this is important for monitoring fluid status. tell patients to weigh themselves at the same time each day. ideally this should be before breakfast, using the same scale, wearing the same type of clothing. this helps ensure valid comparisons fro day to day and helps identify early signs of fluid retention **weight changes may signify a progressive weight gain from fluid retention and renal failure may also contribute to fluid retention

nursing diagnoses r/t heart failure

- impaired gas exchange r/t increased preload and alveolar-capillary membrane changes - decreased cardiac output r/t altered contractility, altered preload, and/or altered stroke volume - excess fluid volume r/t increased venous pressure and decreased renal perfusion secondary to heart failure - activity intolerance r/t imbalance between O2 supply and demand secondary to cardiac insufficiency and pulmonary congestion

discharge teaching for patient with reduced ejection fraction (HFrEF)

- signs and symptoms f HF exacerbation: what to do/report, importance of early detection - can heave positive outlook with chronic health problem if treatment plan is followed - drug therapy: expected actions, signs of drug toxicity, how to take HR and what to report, signs and symptoms of hypo and hyperkalemia, BP monitoring as needed - dietary therapy, activity/rest, ongoing monitoring, health promotion

a nurse is completing discharge teaching with a client who has heart failure and is encouraged to increase potassium in his diet. which of the following food selections should the nurse include as having the highest source of potassium? - 1 medium apple - 1 medium baked potato - 1 slice toast with 1 tbsp peanut butter - 1 large scrambled egg

1 medium baked potato

a nurse is teaching a client who has heart failure about the need to limit sodium in the diet to 2,000 mg daily. which of the following foods should the nurse recommend for the client? (select all that apply) - 1 slice cheddar cheese - 1 medium beef hot dog - 3 oz atlantic salmon - 3 oz roasted chicken breast - 2 oz lean baked ham

1 slice cheddar cheese 3 oz atlantic salmon 3 oz roasted chicken breast

exacerbation of heart failure - assessment findings needing immediate reaction

FACES = fatigue, limitation of activities, chest congestion/cough, edema, shortness of breath

patient has PUD. what to teach to patient about H-pylori infection?

NSAIDs increase risk of PUD

the pernicious anemia that may accompany gastritis is due to...

a lack of intrinsic factor normally produced by acid-secreting cells of the gastric mucosa

what patient history creates risk for intracardiac thrombi?

actue myocardial infarction and atrial fibrillation

76 y/o with fecal impaction - action to take first by nurse

administer a tap water enema. if that does not work, nurse must obtain order for digital removal of stool

a nurse is caring for a client who has a new dx of GERD. the nurse should anticipate prescriptions for which of the following medications? (sata) - antacids - histamine2 receptor antagonists - opioid analgesics - fiber laxatives - proton pump inhibitors

antacids histamine2 receptor antagonists proton pump inhibitors

a nurse is caring for a client who has heart failure and reports increased SOB. the nurse increases the client's O2 per protocol. which of the following actions should the nurse take first? - obtain the client's weight - assist the client into high fowler's position - auscultate lungs sounds - check O2 saturation with pulse oximeter

assist the client into high fowler's position

what is the assessment for patient who just vomited bright red blood and is constipated?

bright red blood indicates active bleeding. - MalloryWeiss tear (disruption of mucosal lining near esophagogastric junction) - esophageal varices - gastric or duodenal ulcer or neoplasm pt needs IV fluids, may need an NG tube

GERD, increased gastric emptying may relieve symptoms - drugs prescribed?

cholinergic drugs - Buthanechol (Urecholine)

NPO due to nausea, when oral intake is restarted, the nurse offers...?

clear liquid in small amounts. if the client can tolerate, intake increases gradually

a nurse is completing an assessment of a client who has a gastric ulcer. which of the following findings should the nurse expect? (sata) - client reports pain relieved by eating - client states that pain often occurs at night - client reports sensation of bloating - client states that pain occurs 30 min to 1 hr after eating - client experiences pain upon palpation of the epigastric region

client reports sensation of bloating client states that pain occurs 30 min to 1 hr after eating client experiences pain upon palpation of the epigastric region

the nurse recognizes that primary manifestations of systolic failure include - dec. EF and inc. PAWP (pulmonary artery wedge pressure) - dec. PAWP and inc. EF - dec. pulmonary hypertension associated with normal EF - dec. afterload and dec. left ventricular end-diastolic pressure

dec. EF and inc. PAWP

what are the assessment findings for patient on metoprolol?

decreased HR, decreased myocardial contractility, decreased CO, promoted excretion of sodium and water, bradycardia, orthostatic hypotension

what assessment finding is related to deficit of intrinsic factor production?

deficiency of vitamin B12 (intrinsic factor is a glycoprotein that is produced by parietal cells in the stomach and necessary for the absorption of B12 in the terminal ileum)

discharge teaching for patient with chronic heart failure on digoxin and HCTZ

digoxin - count pulse for 1 min before taking. if pulse is irregular or outside normal range, hold dose and contact provider - take at the same time everyday - do not take at the same time as antacids (separate by at least 2 hrs) - report signs of toxicity including fatigue, muscle weakness, confusion, and loss of appetite - regularly have digoxin and potassium levels checked HCTZ - ingest food and drinks that are high in potassium to counter the effects of hypokalemia

signs and symptoms to indicate left-sided heart failure

dyspnea, orthopnea, nocturnal dyspnea, displaced apical pulse, S3 heart sounds, pulmonary congestion, frothy sputum, altered mental status, manifestations of organ failure

how would you teach PUD to patients?

follow diet modifications, avoid cigarettes, reduce alcohol intake, avoid OTC unless approved by HCP, take all meds as prescribed, report nausea/vomiting, increased epigastric pain, blood/tarry stools, learn stress management, discuss lifestyle changes

what is the potential cause for bright red streaking blood on the surface of stool?

hemorrhoids

you are caring for a patient with ADHF who is receiving IV dobutamine (Dobutrex). you know that this drug is ordered because it.. (sata) - increases SVR - produces diuresis - improves contractility - dilates renal blood vessels - works on the beta1-recpetors in the heart

improves contractility works on the beta1-recpetors in the heart

area of gastric tract responsible for development of GERD

incompetent lower esophageal sphincter (LES); lets gastric contents move from the stomach to the esophagus when patient is supine or has an increase in intra-abdominal pressure

action for c/o diarrhea for 24 hours, 25 y/o male patient

increase fluid intake to replenish loss of electrolytes

a nurse is teaching a client who has a new dx of dumping syndrome following gastric surgery. which of the following information should the nurse include in the teaching? - eat 3 moderate-sized meals a day - drink at least one glass of water with each meal - eat a bedtime snack that contains a milk product - increase protein in the diet

increase protein in the diet

performing abdominal assessment - examination sequence to follow?

inspection, auscultation, percussion, palpation

patient with right-sided heart failure - assessment most consistent

left-sided heart failure; right ventricular MI, pulmonary problems (COPD, pulmonary fibrosis); peripheral edema

what is the required intervention of patients with pernicious anemia?

lifelong cobalamin (B12) therapy (B12 shots or pills)

a nurse is completing an assessment of a client who has GERD. which of the following is an expected finding? - absence of saliva - loss of tooth enamel - sweet taste in mouth - absence of eructation

loss of tooth enamel

a patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. to prevent possible complications of this combination of drugs, what does the nurse need to do? (sata) - monitor serum potassium levels - teach the pt how to take pulse rate - keep an accurate measure of intake and output - teach the pt about dietary restriction of potassium without digitalis and notify the provider if pulse is irregular

monitor serum potassium levels teach the pt how to take pulse rate

a compensatory mechanism involved with HF that leads to inappropriate fluid retention and additional workload of the heart is - ventricular dilation - ventricular hypertrophy - neurohormonal response - sympathetic nervous system activation

neurohormonal response

PUD, vomiting, c/o sudden severe pain in abdomen, assessment reveals board-like abdomen with rebound tenderness - symptoms indicate?

perforation

verify successful teaching of newly diagnosed heart failure when a patient says they will...

quit smoking; watch fluid intake; avoid alcohol; reduce caffeine intake; eat less fat and cholesterol; be active; maintain healthy weight; practice stress reducing technique

a nurse in the emergency room is contemplating an assessment of a client who has suspected stomach perforation due to a peptic ulcer. which if the following findings should the nurse expect? (sata) - rigid abdomen - tachycardia - elevated BP - circumoral cyanosis - rebound tenderness

rigid abdomen tachycardia rebound tenderness

what are the manifestations of left-sided heart failure?

signs: LV heaves, pulsus alternans, increase HR, PMI displaced inferiorly and left of the midclavicular line, poor O2 exchange, crackles, S3 and S4 heart sounds, pleural effusion, change in mental status, restlessness, confusion symptoms: weakness, fatigue, dyspnea/orthopnea, shallow respirations, nocturnal dyspnea, hypertrophy of the LV, organ failure

what are the manifestations of right-sided heart failure?

signs: RV heaves, jugular venous distention, edema, weight gain, increased HR, hepatomegaly (liver enlargement) symptoms: fatigue, dependent bilateral edema, right upper quadrant pain, anorexia and GI bloating, nausea

82 y/o confuses water pill with heart pill - discharge plan will include?

some diuretics can cause potassium levels in the blood to become too high, causing dangerous heart rhythm and cardiac arrest. if the patient too a tiazide diuretic, their potassium levels can drop too low (hypokalemia), which can cause life-threatening problems with their heartbeat as well.

a nurse is completing the admission assessment of a client who has a suspected pulmonary edema. which of the following manifestation are expected findings? (select all that apply) - tachypnea - persistent cough - increased urinary output - thick, yellow sputum - orthopnea

tachypnea persistent cough orthopnea

a nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. which of the following information should the nurse include in the teaching? (sata) - take the medication 1 hr before a meal - limit NSAIDs when taking this med - expect skin flushing when taking this med - increase fiber intake - chew the medication thoroughly before swallowing

take the medication 1 hr before a meal limit NSAIDs when taking this med

a nurse is admitting a client who has bleeding esophageal varices. the nurse should anticipate the prescription for which of the following medications? - propranolol - metoclopramide - rantidine - vasopressin

vasopressin

which blood vessel carries oxygenated and deoxygenated blood?

veins carry oxygenated blood. arteries carry deoxygenated blood.