Medsurg individual quiz (54,55,56,57,58,59)

A patient with colorectal cancer was started on 5-fluorouracil (5-FU) and is experiencing fatigue, diarrhea, and mouth ulcers. What does the nurse tell the patient about the cause of diarrhea and mouth ulcers? "A combination of chemotherapeutic agents has caused them." "GI problems are symptoms of the advanced stage of your disease." "5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea." "You have these as a result of the radiation treatment."

"5-FU cannot discriminate between your cancer and your healthy cells and is causing your ulcers and diarrhea."

The home health nurse is teaching a patient about the care of a new colostomy. Which patient statement demonstrates a correct understanding of the instructions? "A dark or purplish-looking stoma is normal and would not concern me." "If the skin around the stoma is red or scratched, it will heal soon." "I need to check for leakage underneath my colostomy." "I need to strive for a very tight fit when applying the barrier around the stoma."

"I need to check for leakage underneath my colostomy."

A patient with irritable bowel syndrome (IBS) is constipated. The nurse instructs the patient about a management plan. Which patient statement shows an accurate understanding of the nurse's teaching? "A cup (236 mL) of caffeinated coffee with cream & sugar at dinner is OK for me." "I need to go for a walk every evening." "Maintaining a low-fiber diet will manage my constipation." "Limiting the amount of fluid that I drink with meals is very important."

"I need to go for a walk every evening."

A patient who has been diagnosed recently with esophageal cancer states, "I'm not comfortable going to my father's birthday lunch at our family-owned restaurant because I'm afraid I'll choke in public." What is the nurse's best response?

"Tell me more about the lunch, what will be served and who is going with you." The nurse's best response is to ask the patient for more information to help determine the specific fear and discuss possible alternatives so choking and/or fear of choking can be minimized or avoided in public.Telling the patient not to worry about it or to call the provider is evasive and unhelpful; it is used to placate the patient and does not address the patient's concerns. The patient should use problem-solving and coping skills before resorting to the use of medication.

Which patient does the charge nurse assign to an experienced LPN/LVN? A 28-year-old who requires teaching about how to catheterize a Kock ileostomy A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy A 34-year-old with ulcerative colitis (UC) who has a white blood cell count of 23,000/mm3 (23 × 109/L) A 38-year-old with gastroenteritis who is receiving IV fluids at 250 mL/hr

A 30-year-old who must receive neomycin sulfate (Mycifradin) before a colectomy

An intensive care unit (ICU) RN is "floated" to the medical-surgical unit. Which patient does the charge nurse assign to the float nurse? A 28-year-old with an exacerbation of Crohn's disease (CD) who has a draining enterocutaneous fistula A 32-year-old with ulcerative colitis (UC) who needs discharge teaching about the use of hydrocortisone enemas A 34-year-old who has questions about how to care for a newly created ileo-anal reservoir A 36-year-old with peritonitis who just returned from surgery with multiple drains in place

A 36-year-old with peritonitis who just returned from surgery with multiple drains in place

The nurse is teaching a group of patients with irritable bowel syndrome (IBS) about complementary and alternative therapies. What does the nurse suggest as possible treatment modalities? Select all that apply. Acupuncture Decreasing physical activities Meditation Peppermint oil capsules Yoga

Acupuncture meditation peppermint oil capsules yoga

Aside from chemotherapeutic agents, what other medications does the nurse expect to administer to a patient with advanced colorectal cancer for relief of symptoms? Analgesics and antiemetics Analgesics and benzodiazepines Steroids and analgesics Steroids and anti-inflammatory medications

Analgesics and antiemetics

The nurse is teaching a patient who recently began taking sulfasalazine (Azulfidine) about the drug. What side effects does the nurse tell the patient to report to the primary health care provider? Select all that apply. Anorexia Depression Drowsiness Frequent urination Headache Vomiting

Anorexia Headache vomiting

A patient in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first?

Ask the patient about oral intake, current medications and description of episodes.

A male patient in a long-term care facility is 2 days postoperative after an open repair of an indirect inguinal hernia. Which nursing action does the RN delegate to unlicensed assistive personnel (UAP)? Assessing the patient's incision for signs of infection Assisting the patient to stand to void Instructing the patient in how to deep-breathe Monitoring the patient's pain level

Assisting the patient to stand to void

A patient is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possibly contributing to the patient's condition? Select all that apply. Antihistamines Caffeinated drinks Stress Sleeping pills Combinations of genetic, immunological, and hormonal factors

Caffeinated drinks stress Combinations of genetic, immunological and hormonal factors

A patient who has colorectal cancer is scheduled for a colostomy. Which referral is initially of greatest value to this patient? Certified Wound, Ostomy, and Continence Nurse (CWOCN) Home health nursing agency Hospice Hospital chaplain

Certified Wound, Ostomy, and Continence Nurse (CWOCN)

The nurse is observing a coworker who is caring for a patient with a nasogastric tube following esophageal surgery. Which actions by the coworker require the nurse to intervene?

Checking tube placement every 12 hours Keeping the bed flat Providing mouth care every 8 hours

The nurse is assessing a patient with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe?

Dyspepsia excessive salivation Flatulence Regurgitation

A patient with a family history of colorectal cancer (CRC) regularly sees a primary health care provider for early detection of any signs of cancer. Which laboratory result may be an indication of CRC in this patient? Decrease in liver function test results Elevated carcinoembryonic antigen Elevated hemoglobin levels Negative test for occult blood

Elevated carcinoembryonic antigen

A patient with colorectal cancer had colostomy surgery performed yesterday. The patient is very anxious about caring for the colostomy and states that the primary health care provider's instructions "seem overwhelming." What does the nurse do first for this patient? Encourage the patient to look at and touch the colostomy stoma Instruct the patient about complete care of the colostomy Schedule a visit from a patient who has a colostomy and is successfully caring for it Suggest that the patient involve family members in the care of the colostomy

Encourage the patient to look at and touch the colostomy stoma

A patient with a recent surgically created ileostomy refuses to look at the stoma and asks the nurse to perform all required stoma care. What does the nurse do next? Asks the patient whether family members could be trained in stoma care Has another patient with a stoma who performs self-care talk with the patient Requests that the primary health care provider request antidepressants and a psychiatric consult Suggests that the primary health care provider request a home health consultation so stoma care can be performed by a home health nurse

Has another patient with a stoma who performs self-care talk with the patient

A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? Obtain the charts from the previous admission. Listen for bowel sounds in all quadrants. Obtain pulse and blood pressure. Ask about abdominal pain.

Obtain pulse and blood pressure.

Which is a correct statement differentiating Crohn's disease (CD) from ulcerative colitis (UC)? Patients with CD experience about 20 loose, bloody stools daily. Patients with UC may experience hemorrhage. The peak incidence of UC is between 15 and 40 years of age. Very few complications are associated with CD.

Patients with UC may experience hemorrhage.

A patient with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? Administers medication for pain Changes the nasogastric suction level from "intermittent" to "constant" Positions the patient in high-Fowler's position Prepares the patient for emergency surgery

Prepares the patient for emergency surgery

A patient returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this patient after the patient is situated in bed? High Fowler's Lateral Sims' (side-lying) Semi-Fowler's Supine

Semi-Fowler's

A patient at risk for colorectal cancer asks the nurse, "Can you tell me some foods to include in my diet so that I can reduce my chances of getting this disease?" Which dietary selection does the nurse suggest? Steak with pasta Spaghetti with tomato sauce Steamed broccoli with turkey Tuna salad with wheat crackers

Steamed broccoli with turkey

A 21-year-old with a stab wound to the abdomen has come to the emergency department (ED). Once stabilized, the patient is admitted to the medical-surgical unit. What does the admitting nurse do first for this patient? Administer pain medication. Assess skin temperature and color. Check on the amount of urine output. Take vital signs.

Take vital signs.

An older female patient is diagnosed with gastric cancer. Which statement made by the patient's family demonstrates a correct understanding of the disorder? "This may be related to her recurring ulcer disease." "This cancer is probably curable with surgery." "Gastric cancer has a strong genetic component." "Thank goodness she won't have to undergo surgery."

This may be related to her recurring ulcer disease." Correct understanding of a patient's diagnosis of gastric cancer is indicated when they family states that the diagnosis could be related to the patient's ulcer disease. Infection with Helicobacter pylori is the largest risk factor for gastric cancer because it carries the cytotoxin-associated antigen A (CagA) gene. Patients with chronic ulcers are probably infected with this organism.Surgery is often not curative because most gastric cancers do not present with symptoms until late in the disease and have a high fatality rate. There is no strong genetic predisposition to gastric cancer. Surgery is part of the treatment.

The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? To aid in digestion of dairy products To reduce portal pressure To promote gastrointestinal (GI) excretion of ammonia To reduce the risk of GI bleeding

To promote gastrointestinal (GI) excretion of ammonia

A patient is being evaluated in the emergency department (ED) for a possible small bowel obstruction. Which signs/symptoms does the nurse expect to assess? Cramping intermittently, metabolic acidosis, and minimal vomiting Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis Metabolic acidosis, upper abdominal distention, and intermittent cramping Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

A patient has an anal fissure. Which intervention most effectively promotes perineal comfort for the patient? Administering a Fleet's enema when needed Applying heat to acute inflammation for pain relief Avoiding the use of bulk-forming agents Using hydrocortisone cream to relieve pain

Using hydrocortisone cream to relieve pain

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

Using sitz baths three times daily

A patient who had surgery for inflammatory bowel disease is being discharged. The case manager will arrange for home health care follow-up. The patient tells the nurse that family members will also be helping with care. What information is critically important for the nurse to provide to these collaborating members? A list of medical supply facilities where wound care supplies may be purchased Proper handwashing techniques to avoid cross-contamination of the patient's wound The amount of pain medication that the patient is allowed to take in each dose Written and oral instructions regarding signs/symptoms to report to the primary health care provider

Written and oral instructions regarding signs/symptoms to report to the primary health care provider

The nurse working during the day shift on the medical unit has just received report. Which patient does the nurse plan to assess first? Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal Middle-aged patient with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy After receiving shift report, the nurse would first assess the post-op total gastrectomy young adult with epigastric pain, hiccups and abdominal pain. This patient is experiencing symptoms of acute gastric dilation, which can disrupt the suture line. The surgeon must be notified immediately because the nasogastric tube may need irrigation or repositioning.The patient who had a subtotal gastrectomy is not in a life-threatening situation and does not require immediate assessment. The patient with gastric cancer and the older adult with advanced gastric cancer are in stable condition and do not require immediate assessment.

A male patient with a long history of ulcerative colitis experienced massive bleeding and had emergency surgery for creation of an ileostomy. He is very concerned that sexual intercourse with his wife will be impossible because of his new ileostomy pouch. How does the nurse respond? "A change in position may be what is needed for you to have intercourse with your wife." "Have you considered going to see a marriage counselor with your wife?" "What has your wife said about your pouch system?" "You must get clearance from your primary health care provider before you attempt to have intercourse."

"A change in position may be what is needed for you to have intercourse with your wife."

The nurse has placed a nasogastric (NG) tube in a patient with upper gastrointestinal (GI) bleeding to administer gastric lavage. The patient asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response?

"A fluid solution goes down the tube to help clean out your stomach." The nurse's best response to the patient with upper GI bleeding about the purpose of a NG tube for gastric lavage is that fluid is put down the tube to clean out the stomach. Gastric lavage involves the instillation of a room-temperature solution of water or saline in volumes of 200 to 300 mL through an NG tube to clear out stomach contents and blood clots.Gastric lavage does not involve the instillation of medication. An NG tube is not typically placed in a patient without a particular purpose in mind. Gastric lavage does not involve enteral feeding.

A Certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a patient about caring for a new ileostomy. What information is most important to include? "After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." "Call your primary health care provider if your stoma has a bluish or pale look." "Notify the primary health care provider if output from your stoma has a sweetish odor." "Remember that you must wear a pouch system at all times."

"Call your primary health care provider if your stoma has a bluish or pale look."

A nurse is teaching a patient about dietary methods to help manage exacerbations (flare-ups) of diverticulitis. What does the nurse advice the patient? "Be sure to maintain an exclusively low-fiber diet to prevent pain on defecation." "Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet." "Maintain a high-fiber diet to prevent the development of hemorrhoids that frequently accompany this condition." "Make sure you consume a high-fiber diet while diverticulitis is active. When inflammation resolves, consume a low-fiber diet."

"Consume a low-fiber diet while your diverticulitis is active. When inflammation resolves, consume a high-fiber diet."

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."

"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.

A patient with an exacerbation of ulcerative colitis has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving signs/symptoms. How does the nurse reply? "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." "It provides key nutrients and extra calories to promote healing." "It is bland and reduces the secretion of gastric acids." "It does not contain caffeine or other GI tract stimulants."

"It is absorbed quickly and allows the affected part of the GI tract to rest and heal."

A patient with ulcerative colitis (UC) has stage 1 of a restorative proctocolectomy with ileo-anal anastomosis (RPC-IPAA) procedure performed. The patient asks the nurse, "How long do people with this procedure usually have a temporary ileostomy?" How does the nurse respond? "It is usually ready to be closed in about 1 to 2 months." "You need to talk to your primary health care provider about how long you will have this temporary ileostomy." "The period of time is indefinite—I am sorry that I cannot say." "You will probably have it for 6 months or longer, until things heal."

"It is usually ready to be closed in about 1 to 2 months."

A patient with gastroesophageal reflux disease has undergone a laparoscopic Nissen fundoplication (LNF). What will the nurse include in postoperative home care instructions?

"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 colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this patient? "Are you afraid of what your spouse will think of the colostomy?" "Don't worry. You will get used to the colostomy eventually." "Tell me what worries you the most about this procedure." "Why are you so afraid of having this procedure done?"

"Tell me what worries you the most about this procedure."

A male patient's sister was recently diagnosed with colorectal cancer (CRC), and his brother died of CRC 5 years ago. The patient asks the nurse whether he will inherit the disease too. How does the nurse respond? "Have you asked your primary health care provider what he or she thinks your chances are?" "It is hard to know what can predispose a person to develop a certain disease." "No. Just because they both had CRC doesn't mean that you will have it, too." "The only way to know whether you are predisposed to CRC is by genetic testing."

"The only way to know whether you are predisposed to CRC is by genetic testing."

A patient with malabsorption syndrome asks the nurse, "What did I do to cause this disorder to develop?" How does the nurse respond? "An excessive intake of alcohol is associated with it, so your substance abuse could have contributed to its development." "It is inherited, so it could run in your family." "It might be caused by a virus, so you could have gotten it almost anywhere." "There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

"There are a variety of things that can cause malabsorption syndrome to occur. You may have a deficiency is certain enzymes, a bacteria or changes in the lining of your intestines."

The RN receives a change-of-shift report about four patients. Which patient does the nurse assess first? A 20-year-old with ulcerative colitis (UC) who had six liquid stools during the previous shift A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F (37.9°C) A 56-year-old who had a colon resection earlier in the day and whose colostomy bag does not have any stool in it A 60-year-old admitted with acute gastroenteritis who is reporting severe cramping and nausea

A 25-year-old who has just been admitted with possible appendicitis and has a temperature of 102°F (37.9°C)

The nurse is instructing a patient with recently diagnosed diverticular disease about diet. What food does the nurse suggest the patient include? A slice of 5-grain bread Chuck steak patty (6 ounces [170 grams]) Strawberries (1 cup [160 grams]) Tomato (1 medium)

A slice of 5-grain bread

A home health patient has had severe diarrhea for the past 24 hours. Which nursing action does the RN delegate to the home health aide (unlicensed assistive personnel [UAP]) who assists the patient with self-care? Instructing the patient about the use of electrolyte-containing oral rehydration products Administering loperamide (Imodium) 4 mg from the patient's medicine cabinet Checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions Teaching the patient how to clean the perineal area after each loose stool

Checking and reporting the patient's heart rate and blood pressure in lying, sitting, and standing positions

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

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.

A patient has vague symptoms that indicate an acute inflammatory bowel disorder. Which signs/symptoms are most indicative of Crohn's disease (CD)? Abdominal pain relieved by bending the knees, constipation Chronic diarrhea, abdominal colicky pain, and fever Epigastric cramping & persistent rectal bleeding Hypotension with vomiting and headache

Chronic diarrhea, abdominal colicky pain, and fever

A patient with a bowel obstruction is ordered a Salem sump nasogastric tube (NGT). After the nurse inserts the tube, which nursing intervention is the highest priority for this patient? Attaching the tube to low intermittent suction Auscultating for bowel sounds and peristalsis while the suction runs Connecting the tube to low continuous suction Flushing the tube with 30 mL of normal saline every 24 hours

Connecting the tube to low continuous suction

A patient with ulcerative colitis (UC) is prescribed sulfasalazine (Azulfidine) and corticosteroid therapy. As the disease improves, what change does the nurse expect in the patient's medication regimen? Corticosteroid therapy will be stopped. Sulfasalazine (Azulfidine) will be stopped. Corticosteroid therapy will be tapered. Sulfasalazine (Azulfidine) will be tapered.

Corticosteroid therapy will be tapered.

The nurse is caring for a patient with esophageal cancer who has received photodynamic therapy using porfimer sodium (Photofrin). What instructions does the nurse include in teaching the patient about porfimer sodium?

Cover or shield all exposed body areas from sunlight. Follow a clear liquid diet for 3 to 5 days after the procedure. Tissue particles may be found in the sputum.

The nurse is working with the dietitian to plan a menu for a patient who has persistent difficulty swallowing. What is a suitable breakfast selection for this patient?

Cream of wheat and applesauce A breakfast selection of both cream of wheat and applesauce are foods of semisolid consistency and are appropriate for this patient. The patient who is having difficulty swallowing would be given semisolid foods and thickened liquids.Toast would not be appropriate, and orange juice would have to be thickened before it is given to this patient. An English muffin would be inappropriate for this patient because it is not a semisolid food.

A patient is scheduled to be discharged home after a gastrectomy and will need to perform daily dressing changes on the surgical wound. What is the nurse's highest priority intervention? Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider Asking the primary health care provider for a referral for home health services to assist with dressing changes Asking the spouse if any other family members are in the medical profession and could help change the dressing Offer literature on dressing changes and schedule follow-up phone calls with the patient and spouse to talk them through dressing changes when at home.

Providing both oral and written instructions to the patient and his spouse on changing the dressing and on symptoms of infection that must be reported to the provider

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."

A nurse is teaching a patient with Crohn's disease about managing the disease with the drug adalimumab (Humira). Which instruction does the nurse emphasize to the patient? "Avoid large crowds and anyone who is sick." "Do not take the medication if you are allergic to foods with fatty acids." "Expect difficulty with wound healing while you are taking this drug." "Monitor your blood pressure and report any significant decrease in it."

"Avoid large crowds and anyone who is sick."

A patient diagnosed with ulcerative colitis (UC) is to be discharged on loperamide (Imodium) for symptomatic management of diarrhea. What does the nurse include in the teaching about this medication? "Be aware of the signs/symptoms of toxic megacolon that we discussed." "If diarrhea increases, you must let your primary health care provider know." "You must avoid pregnancy." "You will need to decrease your dose of sulfasalazine (Azulfidine)."

"Be aware of the signs/symptoms of toxic megacolon that we discussed."

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."

"Consume extra fluids to replace fluid losses."

The nurse is teaching a patient how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the patient demonstrates a correct understanding of the nurse's instruction? "It is okay to continue to drink coffee in the morning when I get to work." "I will need to take vitamin B12 shots for the rest of my life." "I should avoid alcohol and tobacco." "I should eat small meals about six times a day."

"I should avoid alcohol and tobacco." The patient's statement that he/she needs to avoid alcohol and tobacco shows that the patient correctly understands the nurse's instructions. The patient with chronic gastritis should avoid alcohol and tobacco.The patient also needs to eliminate caffeine from the diet. The patient will need to take vitamin B12 shots only if he/she has pernicious anemia. The patient would also not eat six small meals daily. This practice may actually stimulate gastric acid secretion.

The Certified Wound, Ostomy, and Continence Nurse is teaching a patient with colorectal cancer how to care for a newly created colostomy. Which patient statement reflects a correct understanding of the necessary self-management skills? "I will have my spouse change the bag for me." "If I have any leakage, I'll put a towel over it." "I can put aspirin tablets in the pouch in order to reduce odor" "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag."

"I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag."

The nurse is teaching a patient who has undergone a hemorrhoidectomy about a follow-up plan of care. Which patient statement demonstrates a correct understanding of the nurse's instructions? "I would take Ex-Lax after the surgery to 'keep things moving'." "I will need to eat a diet high in fiber." "Limiting my fluids will help me with constipation." "To help with the pain, I'll apply ice to the surgical area."

"I will need to eat a diet high in fiber."

A 24-year-old male is scheduled for a minimally invasive inguinal hernia repair (MIIHR). Which patient statement indicates a need for further teaching about this procedure? "I may have trouble urinating immediately after the surgery." "I will need to stay in the hospital overnight." "I will not eat after midnight the day of the surgery." "My chances of having complications after this procedure are slim."

"I will need to stay in the hospital overnight."

A patient suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the patient about this test? "During the test, you will drink small amounts of an antacid as directed by the technician." "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." "The test will take between 30 and 45 minutes to complete." "You must have nothing to drink (except water) for 24 hours before the test."

"If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS."

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."

"These herbs could be helpful. However, you should talk with your primary health care provider before adding them to your treatment regimen."

A patient has a long-term history of Crohn's disease and has recently developed acute gastritis. The patient asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." "What has your doctor told you about how your gastritis developed?" "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"

"We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." The nurse's best response is that Crohn's disease may be an underlying disease process when chronic gastritis develops, but not when acute gastritis occurs. It is not known to be a direct cause of the disease.Although Crohn's disease tends to run in families, gastritis is a symptom of other disease processes. It is not a disease process in and of itself. Asking the patient what the doctor has said is an evasive response on the part of the nurse and does not help answer the patient's question.

A patient has been diagnosed with terminal esophageal cancer. The patient is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response?

"Would you like me to get a nurse from hospice to come talk with you?" The best way to alleviate the patient's concerns would be to have a hospice nurse talk with the patient and answer any questions.Suggesting that the patient has had adequate pain management sounds defensive. Referring the patient to the chaplain or the primary health care provider is evasive and attempts to shift responsibility away from the nurse.

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."

"You may have consumed contaminated food or water."

A patient newly diagnosed with ulcerative colitis (UC) is started on sulfasalazine (Azulfidine). What does the nurse tell the patient about why this therapy has been prescribed? "It is to stop the diarrhea and bloody stools." "This will minimize your GI discomfort." "With this medication, your cramping will be relieved." "Your intestinal inflammation will be reduced."

"Your intestinal inflammation will be reduced."

The RN on the medical-surgical unit receives a shift report about four patients. Which patient does the nurse assess first? A 34-year-old who has returned to the unit after a colon resection with a new colostomy stoma, which is pink and moist. A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern A 40-year-old with a reducible inguinal hernia asking questions about surgery. A 51-year-old with familial adenomatous polyposis (FAP) who is scheduled for a colonoscopy

A 36-year-old admitted after a motor vehicle collision (MVC) with areas of ecchymosis on the abdomen in a "lap-belt" pattern

A patient is scheduled for discharge after surgery for inflammatory bowel disease. The patient's spouse will be assisting home health services with the patient's care. What is most important for the home health nurse to assess in the patient and the spouse with regard to the patient's home care? Ability of the patient and spouse to perform incision care and dressing changes Effective coping mechanisms for the patient and spouse after the surgical experience Knowledge about the patient's requested pain medications Understanding of the importance of keeping scheduled follow-up appointments

Ability of the patient and spouse to perform incision care and dressing changes

The nurse finds a patient vomiting coffee-ground emesis. On assessment, the patient has a blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? Administering a histamine2 (H2) antagonist Initiating enteral nutrition Administering intravenous (IV) fluids Administering antianxiety medication

Administering intravenous (IV) fluids The nurse's first priority is to administer intravenous (IV) fluids. Administering IV fluids is necessary to treat the hypovolemia caused by acute gastrointestinal (GI) bleeding.Administration of an H2 antagonist will not treat the basic problem, which is upper GI bleeding. Enteral nutrition will not be part of the treatment plan for acute GI bleeding. Administration of antianxiety medication will not treat the acute confusion. The patient's change in mental status is due to hypovolemia caused by acute GI bleeding.

A patient with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds (2.3 kg) of body weight has been regained. The patient is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this patient? Explain to the patient the importance of drinking the enteral supplements prescribed. Ask the patient's family to try to persuade the patient to drink the supplements. Inform the patient that a nasogastric tube may be necessary if he or she fails to comply. Ask the patient if a change in flavor would make the supplement more palatable.

Ask the patient if a change in flavor would make the supplement more palatable. The highest priority nursing intervention for this patient is to ask the patient if a change in flavor would make the supplement more palatable. This action helps show that the nurse is attempting to determine why the patient is not drinking the supplements. Many patients don't like certain supplement flavors.The nurse would not assume that the patient does not understand the importance of drinking the supplements or that the patient requires persuasion to drink the supplements. The problem may be entirely different. Telling the patient that a nasogastric tube may be necessary could be construed as threatening the patient.

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?

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.

It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? Right shoulder pain Polyuria Bone marrow suppression Bleeding

Bleeding

The nurse is monitoring a patient with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding? Respiratory rate from 24 to 20 breaths/min Apical pulse from 80 to 72 beats/min Temperature from 97.9° F to 98.9° F (36.6°C to 37.2°C) Blood pressure from 140/90 to 110/70 mm Hg

Blood pressure from 140/90 to 110/70 mm Hg A decrease in blood pressure from 140/90 to 110/70 is the most indicative sign of bleeding.A slight decrease in respiratory rate, apical pulse, and temperature is not the primary indication of bleeding.

The nurse is teaching a patient with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? Select all that apply. Broccoli Buttermilk Mushrooms Onions Peas Yogurt

Broccoli mushrooms onions peas

What does the nurse advice a patient diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? Bulk-forming laxatives Saline laxatives Stimulant laxatives Stool-softening agents

Bulk- forming laxatives

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?

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.

A patient with a history of osteoarthritis has a 10-inch (25.5 cm) incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the patient's care does the nurse make certain to discuss with the primary health care provider before the patient's discharge? Having a home health consultation for wound care Requesting an antianxiety medication Requesting pain medication for the patient's osteoarthritis Placing the patient in a skilled nursing facility for rehabilitation

Having a home health consultation for wound care

The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colostomy. Which patient statement demonstrates that additional instruction from the nurse is needed? "I can drive my car in about 2 weeks." "I need to avoid drinking carbonated sodas." "It may take 6 weeks to see the effects of some foods on my bowel patterns." "Stool softeners will help me avoid straining."

I can drive my car in about 2 weeks

The admission assessment for a patient with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? Type and crossmatch for 4 units of packed red blood cells. Infuse 0.9% normal saline solution at 200 mL/hr. Give pantoprazole (Protonix) 40 mg IV now and then daily. Insert a nasogastric tube and connect to low intermittent suction.

Infuse 0.9% normal saline solution at 200 mL/hr. The nurse must first infuse 0.9% normal saline solution at 200 mL/hr for the patient with acute gastric bleeding and hypotension associated with volume loss. The most rapidly available volume expanders are crystalloids to treat hypovolemia.A type and crossmatch, administration of pantoprazole, and insertion of a nasogastric tube must all be done, but the nurse's immediate concern is correcting the patient's hypovolemia.

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

Ingestion of parasites in the water

What is the mechanism of action for the chemotherapeutic drug cetuximab (Erbitux)? It destroys the cancer's cell wall, which will kill the cell. It decreases blood flow to rapidly dividing cancer cells. It stimulates the body's immune system and stunts cancer growth. It blocks factors that promote cancer cell growth.

It blocks factors that promote cancer cell growth.

The nurse is reviewing orders for a patient with possible esophageal trauma after a car crash. Which request does the nurse implement first?

Keep the patient nothing by mouth (NPO) to prevent further leakage of esophageal contents. The nurse first implements the request to keep the patient NPO, because patients with possible esophageal tears need to be NPO until diagnostic testing is completed. Leakage of anything taken orally into the sterile mediastinum could occur. In addition, esophageal rest is maintained for about 10 days after esophageal trauma to allow time for mucosal healing.TPN is prescribed to provide calories and protein for wound healing. Although TPN is important, it is not a priority for the nurse to implement first. Antibiotics may be requested to prevent possible infection, but this is not the priority. A CT of the chest and abdomen will be needed but is not the nurse's initial action.

A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices? "Drinking carbonated beverages will help with your abdominal distress." "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." "Lactose-containing foods should be reduced or eliminated from your diet." "Raw vegetables and high-fiber foods may help to diminish your symptoms."

Lactose-containing foods should be reduced or eliminated from your diet."

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)

Loperamide (Imodium)

The nurse is caring for a patient diagnosed with esophageal cancer who is experiencing diarrhea after conventional esophageal surgery. The nurse anticipates that the primary health care provider will request which medication to manage diarrhea?

Loperamide (Imodium) The nurse anticipates that the primary health care provider will order Loperamide to manage the diarrhea. Diarrhea is thought to be the result of vagotomy syndrome, which develops as a result of interruption of vagal fibers to the abdominal viscera during surgery. It can occur 20 minutes to 2 hours after eating and can be symptomatically managed with loperamide.Mesalamine is used to treat patients with mild to moderate ulcerative colitis. Minocycline is an antibiotic used for treatment of infection. Pantoprazole is used to treat gastroesophageal reflux disease.

Which of these assigned patients does the nurse assess first after receiving the change-of-shift report?

Middle-aged adult with an esophagectomy done 2 days earlier who has bright-red drainage from the nasogastric (NG) tube The nurse must first assess the postoperative esophagectomy patient with bright red NG tube drainage. The presence of blood in NG drainage is an unexpected finding 2 days after esophagectomy and requires immediate investigation.The young adult scheduled for a CT scan, the adult with GERD, and the older adult with an ileus are all stable and do not require the nurse's immediate attention.

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)

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 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."

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 caring for an older adult male patient who reports stomach pain and heartburn. Which sign/symptom is most significant suggesting the patient's ulceration is duodenal in origin and not gastric? Pain occurs 1½ to 3 hours after a meal, usually at night. Pain is worsened by the ingestion of food. The patient has a malnourished appearance. The patient is a man older than 50 years.

Pain occurs 1½ to 3 hours after a meal, usually at night. A key symptom of duodenal ulcers is that pain usually awakens the patient between 1:00 a.m. and 2:00 a.m. and occurs 1½ to 3 hours after a meal.Pain that is worsened with ingestion of food and a malnourished appearance are key features of gastric ulcers. A male over 50 years is a finding that could apply to either type of ulcer.

The nurse is reviewing admitting requests for a patient admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? Apply antiembolism stockings. Place a nasogastric (NG) tube, and connect to suction. Insert an indwelling catheter, and check output hourly. Give famotidine (Pepcid) 20 mg IV every 12 hours.

Place a nasogastric (NG) tube, and connect to suction. When caring for an ICU patient with a perforated duodenal ulcer, the nurse or primary care provider must first insert a nasogastric (NG) tube and connect it to suction. To decrease spillage of duodenal contents into the peritoneum, NG suction would be rapidly initiated. This will minimize the risk for peritonitis.Antiembolism stockings will need to be applied, monitoring urined output is important, and famotidine (Pepcid) will need to be administered, but these are done after the NG tube is inserted and connected to suction.

The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to a patient diagnosed with esophageal cancer. Which of the following instructions should be included in the teaching?

Place food at the back of the mouth as you eat. The nurse should instruct the patient to place food at the back of the mouth when eating. This will help the patient avoid aspiration of food. Food aspiration can cause airway obstruction, pneumonia, or both, especially in older adults.Both tongue movements and sealing of the lips should be monitored in this patient. The patient's head should be tilted forward in the chin-tuck position and not back. The patient needs to be able to reach food particles on her or his lips and around the mouth with the tongue.

Which patient assessment information is correlated with a diagnosis of chronic gastritis? Anorexia, nausea, and vomiting Frequent use of corticosteroids Hematemesis and anorexia Radiation therapy, smoking, and excessive alcohol use

Radiation therapy, smoking, and excessive alcohol use Treatment with radiation therapy, smoking, and alcohol use are known to be associated with the development of chronic gastritis.Anorexia, nausea, and vomiting are all signs and symptoms of acute gastritis. Corticosteroid use and hematemesis are also more likely to be signs and symptoms of acute gastritis.

A 67-year-old male patient, with no surgical history, reports pain in the inguinal area that occurs when he coughs. A bulge that can be pushed back into the abdomen is found in his inguinal area. What type of hernia does he have? Femoral Reducible Strangulated Incarcerated

Reducible

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? Retape the nasogastric tube for a patient who has had a subtotal gastrectomy and vagotomy. Reinforce the teaching previously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis. Document instructions for a patient with chronic gastritis about how to use "triple therapy." Assess the gag reflex for a patient who has arrived from the post anesthesia care unit after a laparoscopic gastrectomy.

Reinforce the teaching previously done by the RN about avoiding alcohol and caffeine for a patient with chronic gastritis. The best nursing action to delegate to the experienced LPN/LVN is to reinforce patient teaching previously done by the RN to a patient with chronic gastritis about avoiding alcohol and caffeine. Reinforcement of teaching done by the RN is within the scope of practice for an LPN/LVN.Retaping the nasogastric tube for a patient who has had a subtotal gastrectomy and vagotomy is a complex task that would be done by the RN. Documenting instructions about how to use triple therapy are nursing functions that would be done by the RN. Assessment of a patient's gag reflex is also an RN nursing function.

A patient with an inoperable esophageal tumor is receiving swallowing therapy. Which task does the home health nurse delegate to an experienced home health aide?

Reminding the patient to use the chin-tuck technique each time the patient attempts to swallow The role of a home health aide when caring for a patient with swallowing difficulty includes reinforcement of previously taught swallowing techniques.Teaching and providing instructions to family members are not within the scope of practice of a home health aide and would be done by the home health nurse. Likewise, assessing lung sounds is part of the nursing process and would be done by the nurse.

A patient has been discharged home after surgery for gastric cancer, and a case manager will follow up with the patient. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? Schedule of the patient's follow-up examinations and diagnostic testing Information on family members' progress in learning how to perform dressing changes Copy of the diet plan prepared for the patient by the hospital dietitian Detailed account of what occurred during the patient's surgical procedure

Schedule of the patient's follow-up examinations and diagnostic testing The highest priority information the hospital nurse would give to the home case manager is a schedule of the patient's follow-up exams and diagnostic testing. Because recurrence of gastric cancer is common, it is important for the patient to have follow-up examinations and x-rays so that a recurrence can be detected quickly.It may take family members a long time to become proficient at tasks such as dressing changes. Although the case manager must be aware of the diet, family members will likely be preparing the patient's daily diet, and they would be provided with this information. It is not necessary for the case manager to have details of the patient's surgical procedure unless a significant event occurred during the procedure.

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.

Start an IV solution of 5% dextrose in 0.45 normal saline at 125 mL/hr.

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

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.

An obese patient is discharged 10 days after being hospitalized for peritonitis, which resulted in an exploratory laparotomy. Which assessment finding by the patient's home health nurse requires immediate action? Pain when coughing States, "I am too tired to walk very much" States, "I feel like the incision is splitting open" Temperature of 100.8°F (38.2°C).

States, "I feel like the incision is splitting open"

"A patient is being discharged, 8 days postoperatively following a total esophagectomy." Which teaching point does the nurse consider to be of the highest priority during the transition to home?

Stress the importance of notifying the primary health care provider if leaking is noted at the incision site. The teaching point with the highest priority is to notify the primary health care provider (PHCP) immediately if leaking is noted at the incision site. Leakage from the site of anastomosis is a dreaded complication that can appear 2 to 10 days after surgery. Wound management and prevention of infection are major concerns because the patient who has had an esophagectomy typically has multiple drains and incisions.The patient should eat six to eight small meals daily, and should sit up after meals to encourage satisfactory swallowing. The patient's coping skills should be assessed, as well as his or her level of anxiety and/or depression, before antidepressant medication is prescribed.