PCC 2 Exam 4

The nurse is caring for a patient diagnosed with peptic ulcer disease (PUD). The patient was prescribed the proton pump inhibitor Prevacid (lansoprazole). Which supplement may be prescribed to prevent deficiency?

vitamin B12 Vitamin B12 deficiency can occur as a result of the reduced gastric acidity associated with use of proton pump inhibitors, and supplementation is often warranted.

A nurse assesses a client who is prescribed alosetron (Lotronex). Which assessment question should the nurse ask this client? a. "Have you been experiencing any constipation?" b. "Are you eating a diet high in fiber and fluids?" c. "Do you have a history of high blood pressure?" d. "What vitamins and supplements are you taking?"

A Ischemic colitis is a life-threatening complication of alosetron. The nurse should assess the client for constipation. The other questions do not identify complications related to alosetron.

A nurse cares for a client who has been diagnosed with a small bowel obstruction. Which assessment findings should the nurse correlate with this diagnosis? (Select all that apply.) a. Serum potassium of 2.8 mEq/L b. Loss of 15 pounds without dieting c. Abdominal pain in upper quadrants d. Low-pitched bowel sounds e. Serum sodium of 121 mEq/L

A, C, E

After teaching a client who is recovering from a colon resection, the nurse assesses the client's understanding. Which statements by the client indicate a correct understanding of the teaching? (Select all that apply.) a. "I must change the ostomy appliance daily and as needed." b. "I will use warm water and a soft washcloth to clean around the stoma." c. "I might start bicycling and swimming again once my incision has healed." d. "Cutting the flange will help it fit snugly around the stoma to avoid skin breakdown." e. "I will check the stoma regularly to make sure that it stays a deep red color." f. "I must avoid dairy products to reduce gas and odor in the pouch."

B, C, D The ostomy appliance should be changed as needed when the adhesive begins to decrease. The client should avoid using soap to clean around the stoma because it might prevent effective adhesion of the ostomy appliance. The client should use warm water and a soft washcloth instead. The flange should be cut to fit snugly around the stoma to reduce contact between excretions and the client's skin. Exercise (other than some contact sports) is important for clients with an ostomy. The stoma should remain a soft pink color. A deep red or purple hue indicates ischemia and should be reported to the surgeon right away. Yogurt and buttermilk can help reduce gas in the pouch, so the client need not avoid dairy products.

How does the nurse accurately calculate a client's body mass index (BMI)?

BMI = weight (kg)/height (in meters)^2

A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should the nurse take? a. Ask if the client is experiencing pain in the right shoulder. b. Perform a rectal examination and assess for polyps. c. Contact the provider and recommend computed tomography. d. Administer a laxative to increase bowel movement activity.

C The presence of visible peristaltic waves, accompanied by high-pitched or tingling bowel sounds, is indicative of partial obstruction caused by the tumor.

A patient is taking Bethanechol "Urecholine" for treatment of GERD. This is known as what type of drug? A. Proton-pump inhibitor B. Histamine receptor blocker C. Prokinetic D. Mucosal Healing Agent

C This drug is known as a prokinetic drug. It prevents delayed gastric emptying by improving pressure in lower esophageal sphincter and improves peristalsis of the GI tract.

What is sarcopenia and what causes it?

Defined as: Age related muscle atrophy Four Primary Causes: 1.Senescent musculoskeletal changes 2.Accumulation of chronic disease and medications to treat 3. Disuse Atrophy - most significant and easiest to address 4. Undernutrition

The nurse is assessing a client who is suspected of having early gastric cancer. What signs and symptoms would the nurse expect? (Select all that apply.) a. fatigue b. feeling of fullness c. dyspepsia d. weakness e. weight loss f. nausea and vomiting

b, c The client who has early gastric cancer usually has no or few signs and symptoms, but may have dyspepsia and a feeling of fullness. More distressing changes are manifested when the cancer becomes more advanced.

The nurse is caring for a client who reports stomach pain and heartburn. Which assessment finding is most significant suggesting the client's ulcer is duodenal and not gastric? a. Pain occurs 1½ to 3 hours after a meal, usually at night. b. The client is a man older than 50 years. c. Pain is worsened by the ingestion of food. d. The client has a malnourished appearance.

a A key symptom of duodenal ulcers is that pain usually awakens the client between 1:00 a.m. and 2:00 a.m. (0100 and 0200) 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.

Management of a peptic ulcer in a child often includes which component? a. Taking proton pump inhibitors b. Drinking milk at frequent intervals c. Coping with the stress of a chronic illness d. Taking an antacid an hour before meals and at bedtime

a Proton pump inhibitors block the production of acid. They are well tolerated and have infrequent side effects. Proton pump inhibitors are more effective than antacids.

The nurse is caring for a client with peptic ulcer disease who has been vomiting profusely at home before coming to the emergency department. For which vital sign change will the nurse expect for this client? a. Hypotension b. Tachypnea c. Oxygen desaturation d. Bradycardia

a The client who is vomiting profusely is losing fluids from the body causing dehydration. A client who is dehydrated has hypovolemia resulting in hypotension and tachycardia.

The nurse is teaching a client with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods should be avoided? (Select all that apply.) a. mushrooms b. peas c. onions d. broccoli e. buttermilk f. yogurt

a, b, c, d Foods the patient with a newly created colostomy needs to limit or avoid because of flatulence or odors include: broccoli, mushrooms, onions, and peas. Buttermilk will help prevent odors. Yogurt can help prevent flatus.

The nurse is caring for a client who was recently diagnosed with Helicobacter. pylori infection. Which drugs does the nurse and anticipate would be used for this client to manage the infection? (Select all that apply.) a. metronidazole b. lansoprazole c. azithromycin d. tetracycline e. hydroxychloroquine

a, b, d Most clients who have this type of infection are prescribed to take a proton pump inhibitor, such as lansoprazole, and two antimicrobial drugs, such as metronidazole and tetracycline. Clarithromycin and amoxicillin may be used as alternative antibiotics.

A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms reported by the patient may indicate the patient has GERD? SELECT-ALL-THAT-APPLY:* A. Bitter taste in mouth B. Dry cough C. Melena D. Difficulty swallowing E. Smooth, red tongue F. Murphy's Sign

a, b, d The answers are A, B, D. These are signs and symptoms seen with GERD. Melena is seen with gastrointestinal bleeding as in peptic ulcer disease. Smooth, red tongue is seen with vitamin B12 deficiency, and Murphy's Signs is seen with cholecystitis.

The nurse is assessing a group of patients to determine their risk of vitamin D deficiency. Which of the following patients has the highest risk for vitamin D deficiency? a. A Hispanic female who has a BMI of 24.1 b. An African-American female who is breastfeeding c. An Asian female diagnosed with hypoglycemia d. A Caucasian female who is 39 weeks gestation

b Vitamin D deficiency is more frequently found among persons of African heritage and has increased in prevalence, especially among the infants of breastfeeding African-American mothers.

During a home health visit, you are helping a patient develop a list of foods they should avoid due to GERD. Which items in the patient's pantry should be avoided? SELECT-ALL-THAT-APPLY:* A. Hot and Spicy Pork Rinds B. Peppermint Patties C. Green Beans D. Tomato Soup E. Chocolate Fondue F. Almonds G. Oranges

a, b, d, e, g The answers are A, B, D, E, G. Patients with GERD should avoid foods that relax the lower esophageal sphincter such as greasy/fatty foods (Hot and Spicy Pork Rinds), peppermint (peppermint patties), acidic or citrus foods/juice (tomato soup and oranges), chocolate (chocolate fondue), along with coffee and soft drinks.

The nurse is reviewing medications that can be used for female clients who have constipation-predominant irritable bowel syndrome (IBS). Which drugs are available for this health problem? (Select all that apply.) a. lubiprostone b. cetuximab c. 5-fluorouracil d. psyllium hydrophilic mucilloid e. linaclotide

a, d, e Cetuximab and 5-fluorouracil are chemotherapeutic drugs used for clients who have colorectal cancer. The other drugs are available for female clients who have constipation-predominant IBS.

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

a, d, e, f 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. 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 than foods prepared at home.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. These types of liquid diets should be carefully supervised by a health care provider with special education in weight management.

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

a. The nurse expects that corticosteroid therapy will be tapered as the UC improves in the client who was taking both sulfasalazine and corticosteroids. Once clinical improvement has been established, corticosteroids are tapered over a 2- to 3-month period.

A client returns to the unit after having an exploratory abdominal laparotomy. How does the nurse position this client after being situated in bed? a. Semi-Fowler b. Lateral Sims' (side-lying) c. High Fowler d. Supine

a. The nurse places the postoperative abdominal laparotomy client in the semi-Fowler position in bed. The client is maintained in this position to facilitate the drainage of peritoneal contents into the lower region of the abdominal cavity after an abdominal laparotomy. This position also helps increase lung expansion.

What is anasarca and what is it associated with?

anasarca is severe generalized edema heart, liver, renal failure, extreme protein-calorie malnutrition

A client 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 client? a. Decrease in liver function test results b. Elevated carcinoembryonic antigen c. Negative test for occult blood d. Elevated hemoglobin levels

b Carcinoembryonic antigen may be elevated in many patients diagnosed with CRC. Liver involvement may or may not occur in CRC. Hemoglobin will likely be decreased with CRC, not increased. An occult blood test is not reliable to affirm or rule out CRC.

The nurse and the registered dietitian nutritionist are planning sample diet menus for a client who is experiencing dumping syndrome. Which sample meal is most appropriate for this client? a. Liver, bacon, and onions b. Chicken and white rice c. Chicken salad on whole wheat bread d. Green vegetable salad with buttermilk ranch dressing

b Chicken and rice is the most appropriate sample meal for this client. It is the only selection suitable for the client who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products. The client with dumping syndrome should not have much mayonnaise, onions, or buttermilk ranch dressing. Buttermilk dressing is made from milk products. The client may have whole wheat bread only in very limited amounts.

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

b The nurse teaches the newly diagnosed client with ulcerative colitis that lactose-containing foods are often poorly tolerated and need to be reduced or eliminated from the diet.

The nurse is monitoring a client who is receiving an intravenous fat emulsion (IVFE) nutritional supplement. What action does the nurse take after reviewing the client's laboratory report, and seeing an increase in triglycerides? (Select all that apply.) a. Document the findings and continues to monitor. b. Discontinue the IVFE infusion. c. Slow the rate of flow of the IVFE infusion. d. Offer small bites of oral foods. e. Notify the health care provider.

b, e If a client receiving an IVFE nutritional supplement develops fever, increased triglycerides, clotting problems, or symptoms of multi-system organ failure, the nurse must discontinue the IVFE and notify the HCP. These symptoms may indicate fat overload syndrome, especially in a critically ill patient.Only documenting the findings and continuing to monitor could have serious repercussions for this client. Slowing the rate of flow of the IVFE infusion, or offering small bites of oral foods, can also present a serious safety risk.

The nurse is preparing to administer natalizumab for a client who has Crohn disease (CD). What is the most important client assessment for the nurse to perform before giving this drug? a. Skin integrity b. Body temperature c. Peripheral pulses d. Breath sounds

b. Because this drug may cause a deadly infection that affects the brain (progressive multifocal leukencephalopathy [PML]), the nurse would want to ensure that the client does not have any type of infection. Assessing body temperature is one way to determine the presence of infection.

The nurse is caring for a client admitted with a long-term diagnosis of ulcerative colitis (UC). For what potentially life-threatening complication would the nurse monitor? a. Chronic kidney disease b. Lower gastrointestinal (GI) bleeding c. Metabolic acidosis d. Hyperkalemia

b. The client who has UC is at most risk for lower GI bleeding due to inflammation and diarrhea. The client with UC is also at risk for hypokalemia and metabolic alkalosis as a result of losing intestinal contents through diarrhea.

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

b. These drugs cause immunosuppression and should be used with caution. Clients must be taught to report any signs of a beginning infection, including a cold, and to also avoid others who are sick.

A neonate has been just diagnosed with biliary atresia. What should the nurse consider when providing support to a family whose infant has just been diagnosed? a. Death usually occurs by 6 months of age. b. Prognosis for full recovery is excellent. c. Liver transplantation may be needed eventually. d. Children with surgical correction live normal lives.

c Approximately 80-90% of children with biliary atresia will require liver transplantation. Even with surgical intervention, most children experience liver failure and require transplantation. If untreated, death will usually occur by 2 years of age. Long-term survival is possible with surgical intervention. Liver transplantation is usually required.

The mother of an infant with suspected Hirschsprung disease asks the nurse about the disease because she was too upset to ask the physician. Which explanation by the nurse is best? a. The colon has an aganglionic segment. b. It results in frequent evacuation of solids, liquid, and gas. c. There is a part of the colon that doesn't have the nerves to function. d. It results in excessive peristaltic movements within the gastrointestinal tract.

c Hirschsprung disease is a mechanical obstruction caused by a lack of motility of a segment of the intestine resulting from the lack of innervation by ganglion cells.

A nurse in a home setting is assessing a 79-year-old male patient's risk for malnutrition. The nurse suspects malnutrition when reviewing which laboratory results? (Select all that apply.) a. Waist-to-hip ratio of 1.0 b. Hematocrit level of 50% c. Weight loss of 6% since last month's visit d. Hemoglobin level of 8.2 g/dL e. Body mass index (BMI) of 17 f. Prealbumin level of 16 mg/dL

c, d, e A BMI of 18.5-24.9 is normal, and this patient's BMI is below normal; a major weight loss is defined as more than a 2% weight change over 1 week; and the expected hemoglobin level for a man is 14-18 g/dL. The patient's values may also indicate dehydration. The expected level for prealbumin is 15-36 mg/dL. A hematocrit level of 50% is within normal limits.

The nurse assesses a neonate immediately after birth and suspects a tracheoesophageal fistula. Which assessment data would cause the nurse to suspect this defect? a. Sneezing clear fluid b. Flat anterior and posterior fontanels c. Absence of sucking and swallowing d. An excessive amount of frothy saliva in the mouth

d Excessive salivation and drooling is indicative of tracheoesophageal fistulas. With a fistula, the child has difficulty managing the secretions causing choking, coughing, and cyanosis.

The nurse is working with children with inflammatory bowel disease (IBD). What should the nurse include as essential in the dietary regimen? a. Eating a high-protein, low-calorie diet. b. Including a low-protein but high-caloric intake. c. Ingesting a high-fiber diet. d. Taking daily vitamin supplements.

d Multivitamins, iron, and folic acid supplementation are recommended. A high-protein, high-calorie diet is needed to help correct nutritional deficits. A high-fiber diet is not recommended for IBD. Even small amounts of bran have been associated with a worsening of the child's condition.

The nurse is preparing to provide health teaching for a client who is starting sulfasalazine. Which statement by the client indicates a need for further teaching? a. "I'll let my primary health care provider know if the drug upsets my stomach." b. "I will be sure to take a folic acid supplement while on this drug." c. "I will follow up with getting labs done to check my blood counts." d. "This drug can make me dehydrated because I'm already on a diuretic."

d. Sulfasalazine can cause nausea and vomiting, and can interfere with folic acid absorption. In high doses, it can also cause anemia and agranulocytosis, so blood work would be important for ongoing monitoring. However, the drug does not cause dehydration.

An older adult client is at risk for undernutrition. Which nursing intervention is appropriate to ensure optimum nutritional intake? a. Administering antiemetics and analgesics after meals b. Reminding APs to allow the client to remain in bed during meals c. Turning on the television during meals to provide distraction d. Assisting the client with toileting and oral care prior to meals

d. The appropriate intervention to ensure optimum nutritional intake in an older adult client at risk for undernutrition is to assist the client with toileting and oral care prior to meals for comfort and to prevent these from distracting clients from meals. Antiemetics and analgesics should be provided prior to meals. Clients need to be free from distractions while eating. When possible, clients are placed in chairs for eating.

A client is admitted to the hospital with right lower quadrant abdominal pain, nausea, and vomiting. What assessment would the nurse monitor to identify a potentially life-threatening complication based on the client's condition? a. Intake and output b. Electrolyte values c. Abdominal assessment d. Vital signs

d. The client most likely has appendicitis which can result in perforation of the appendix and peritonitis. If this complication occurs, the client would develop tachycardia and a fever. Therefore, the nurse would monitor for changes in vital signs.

What is the gastrocolic reflex?

increased secretory and motor functions of the stomach result in increased colonic motility