chronic care exam 5

which menu choice by the patient with diverticulosis is best for preventing diverticulitis? a.navy bean soup and vegetable salad b.whole grain pasta with tomato sauce c.baked potato with low-fat sour cream d.roast beef sandwich on whole wheat bread

a. a diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis. although all the choices have some fiber, the bean soup and salad will be the highest in fiber and the lowest in fat.

a nurse is preparing a presentation at a community center about osteoarthritis. the nurse should plan to include which of the following information? (select all that apply.) a.affects weight-bearing joints b.crepitus can occur in affected joints c.affects bilateral, symmetrical joints d.causes joint stiffness e.causes joint pain

a,b,d,e

during assessment of the patient with fibromyalgia, the nurse would expect the patient to report which of the following? (select all that apply.) a.sleep disturbances b.multiple tender points c.cardiac palpitations and dizziness d.multijoint inflammation and swelling e.widespread bilateral, burning musculoskeletal pain

a,b,e these symptoms are commonly described by patients with fibromyalgia. cardiac involvement and joint inflammation are not typical of fibromyalgia.

a nurse is caring for a client who has osteoarthritis and asks about the use of glucosamine. which of the following statements should the nurse make? (select all that apply.) a."glucosamine might increase bleeding. b."glucosamine can help lower blood pressure.' c."glucosamine can increase blood glucose levels." d."glucosamine hydrochloride has been shown to decrease the discomfort of osteoarthritis." e."clients who have shellfish allergies might experience reactions when taking glucosamine."

a,c,e

a nurse is teaching a client who has a new prescription for cimetidine to treat peptic ulcer disease. which of the following statements by the client indicates an understanding of the teaching? (select all that apply.) a."i can take this medication with or without food." b."i will take this medication in the morning." c."i should expect my stools to turn black." d."i will take this medication with an antacid." e."i will take this medication when i need it for the pain." f."i will eat five small meals each day."

a,f

which action would the nurse plan when admitting a patient with acute diverticulitis plan for initial care? a.administer IV fluids. b.prepare for colonoscopy. c.encourage a high-fiber diet. d.give stool softeners and enemas.

a. a patient with acute diverticulitis will be NPO and given parenteral fluids. a diet high in fiber and fluids will be implemented before discharge. bulk-forming laxatives, rather than stool softeners, are usually given. these will be implemented later in the hospitalization. the patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis.

which action will the nurse include in the plan of care for a 25-yr-old male patient with a new diagnosis of irritable bowel syndrome (IBS)? a.encourage the patient to express concerns and ask questions about IBS. b.suggest that the patient increase the intake of milk and other dairy products. c.teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs). d.teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.

a. because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. alosetron has serious side effects and is used only for female patients who have not responded to other therapies. although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.

a nurse is teaching a community education course about the physical complications related to substance use disorder. which of the following findings should the nurse identify as the primary cause of liver cirrhosis? a.alcohol b.caffeine c.cocaine d.inhalants

a. chronic alcohol use disorder is one of the primary causes of cirrhosis of the liver.

after the nurse teaches a 28-yr-old about fibromyalgia, which patient statement indicates a good understanding of effective self-management? a."i will need to stop drinking so much coffee and soda." b."i am going to join a soccer team to get more exercise." c."i will call the doctor every time my symptoms get worse." d."i should avoid using over-the-counter medications for pain."

a. dietitians often suggest patients with fibromyalgia limit their intake of caffeine and sugar because these substances are muscle irritants. mild exercise such as walking is recommended for patients with fibromyalgia, but vigorous exercise is likely to make symptoms worse. because symptoms may fluctuate from day to day, the patient should be able to adapt the regimen independently rather than calling the provider whenever symptoms get worse. over-the-counter medications such as ibuprofen and acetaminophen are frequently used for symptom management.

a young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. which information will the nurse add to a teaching plan about UTIs for this patient that goes beyond a general teaching plan for UTIs? a.fistulas can form between the bowel and bladder. b.bacteria in the perianal area can enter the urethra. c.drink adequate fluids to maintain normal hydration. d.empty the bladder before and after sexual intercourse.

a. fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse.

after having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. what would the nurse plan to teach the patient? a.medication use b.fluid restriction c.enteral nutrition d.activity restrictions

a. medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). decreased activity level is indicated only if the patient has severe fatigue and weakness. fluids are needed to prevent dehydration. there is no advantage to enteral feedings if the patient is able to eat

which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis would the nurse identify as a likely adverse effect of the medication? a.blurred vision b.joint tenderness c.abdominal cramping d.elevated blood pressure

a. plaquenil can cause retinopathy. The medication should be stopped. other findings are not related to the medication although they will also be reported.

a patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. which symptom is most important to communicate to the health care provider? a.fever b.nausea c.joint pain d.headache

a. since infliximab suppresses the immune response, rapid treatment of infection is essential. nausea, joint pain, and headache are common side effects of the medication, but they do not indicate any potentially life-threatening complications.

a nurse is discussing good food choices with a client who is recovering from an exacerbation of inflammatory bowel disease and is to start a low-lactose diet. which of the following foods is the best choice for the client? a.soy milk b.cheddar cheese c.low-fat yogurt d.cottage cheese

a. soy milk us the best choice for this client because soy milk is lactose-free

which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? a.the patient is alert and oriented. b.the patient denies nausea or anorexia. c.the patient's bilirubin level decreases. d.the patient has at least one stool daily.

a. the purpose of lactulose in the patient with cirrhosis is to lower ammonia levels and prevent encephalopathy. although lactulose may be used to treat constipation, that is not the purpose for this patient. lactulose will not decrease nausea and vomiting or lower bilirubin levels.

a nurse is teaching a client who has a hiatal hernia about dietary recommendations. which of the following client statements indicates an understanding of the teaching? (select all that apply.) a."i will lie down for one half hour meals." b."i will consume less caffeine and fewer spicy foods." c."i will sleep with the head of my bed elevated." d."i will try not to gain weight." e."i will drink less fluid."

b,c,d

a nurse is planning care for a client who has manifestations of a Clostridium difficile (C. difficile) infection. which of the following actions should the nurse plan to take? a.place a surgical mask on the client during transport. b.place the client on contact precautions. c.use an alcohol-based agent to perform hand hygiene when caring for the client. d.obtain a blood specimen to test for C. difficile.

b.

a patient who recently had a colon resection for cancer of the colon asks about the purpose of the carcinoembryonic antigen (CEA) test. which explanation would the nurse provide? a.identify any metastasis of the cancer. b.monitor for tumor growth after surgery. c.confirm the diagnosis of a specific type of cancer. d.determine the need for postoperative chemotherapy.

b. CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help to determine whether there is metastasis of the cancer. confirmation of the diagnosis is made based on the biopsy. chemotherapy use is based on factors other than CEA.

a patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. which patient statement to the nurse indicates a need for additional teaching about GERD? a."i quit smoking years ago, but I chew gum." b."i eat small meals and have a bedtime snack." c."i take antacids between meals and at bedtime each night." d."i sleep with the head of the bed elevated on 4-inch blocks."

b. GERD is exacerbated by eating late at night, and the nurse would plan to teach the patient to avoid eating within 3 hours of bedtime. smoking cessation, taking antacids, and elevating the head of the bed are appropriate actions to control symptoms of GERD.

a 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. which information will the nurse include in patient teaching? a.stool will be expelled from both stomas. b.this type of colostomy is usually temporary. c.soft, formed stool can be expected as drainage. d.irrigations can regulate drainage from the stomas.

b. a loop, or double-barrel stoma, is usually temporary. stool will be expelled from the proximal stoma only. the stool from the transverse colon will be liquid and regulation through irrigations will not be possible.

the nurse is assessing a patient who had a total gastrectomy 8 hours ago. which information is most important to report to the health care provider? a.hemoglobin (Hgb) 10.8 g/dL b.temperature 102.1F (38.9C) c.absent bowel sounds in all quadrants d.scant nasogastric (NG) tube drainage

b. an elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. the other findings are expected in the immediate postoperative period for patients who have this surgery and do not require any urgent action.

a patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. which intervention would the nurse include in the patient's plan of care? a.administer oral metoclopramide. b.instruct the patient not to eat or drink. c.administer cobalamin (vitamin B12) injections. d.teach the patient about total colectomy surgery.

b. an initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. metoclopramide increases peristalsis and will worsen symptoms. cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. although total colectomy is needed for some patients, there is no indication that this patient is a candidate during this acute phase.

anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). what information would the nurse include in teaching the patient about this drug? a.avoiding aspirin use b.giving subcutaneous injections c.taking the medication with water d.recognizing gastrointestinal bleeding

b. anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of this medication. Because the medication is injected, instructions to take it with fluid would not be appropriate. the patient is likely to be concurrently taking aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), and these would not be discontinued.

the nurse is caring for a patient who has cirrhosis. which data obtained by the nurse during the assessment will be of most concern? a.the patient reports right upper-quadrant pain with palpation. b.the patient's hands flap back and forth when the arms are extended. c.the patient has ascites and a 2-kg weight gain from the previous day. d.the patient's abdominal skin has multiple spider-shaped blood vessels.

b. asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may occur. the spider angiomas and right upper quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. the ascites and weight gain indicate the need for treatment but not as urgently as the changes in neurologic status.

which screening test would the nurse plan to teach a 45-yr-old male about during an annual wellness exam? a.endoscopy b.colonoscopy c.computerized tomography c.carcinoembryonic antigen (CEA)

b. at age 45 years, persons with an average risk for colorectal cancer (CRC) would begin screening for CRC. colonoscopy is the gold standard for CRC screening. the other diagnostic tests are not recommended as part of a routine annual physical exam at age 45 years.

which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)? a.restrict IV fluid intake. b.monitor stools for blood. c.ambulate six times daily. d.increase dietary fiber intake.

b. because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood. the other actions would not be appropriate for the patient with IBD. a dietary fiber may increase gastrointestinal motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur.

which laboratory result would the nurse monitor to determine if prednisone has been effective for a patient who has an acute exacerbation of rheumatoid arthritis? a.blood glucose b.c-reactive protein c.serum electrolytes d.liver function tests

b. c-reactive protein is a serum marker for inflammation, and a decrease would indicate the corticosteroid therapy was effective. blood glucose and serum electrolytes will also be monitored to assess for side effects of prednisone. liver function is not routinely monitored in patients receiving corticosteroids.

which information would the nurse include when teaching a patient who has an exacerbation of rheumatoid arthritis? a.affected joints should not be exercised when pain is present. b.applying cold packs before exercise may decrease joint pain. c.exercises should be performed passively by someone other than the patient. d.walking may substitute for range-of-motion (ROM) exercises on some days.

b. cold application is helpful in reducing pain during periods of RA exacerbation. because the joint pain is chronic, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints and improve flexibility, so passive ROM alone is not sufficient. recreational exercise is encouraged but is not a replacement for ROM exercises.

which assessment information would indicate to the nurse that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone? a.the patient has joint pain and stiffness. b.the patient's fasting blood glucose is 90 mg/dL. c.the patient has experienced a recent 5-pound weight gain. d.the patient's erythrocyte sedimentation rate (ESR) has increased.

b. corticosteroids increase appetite and lead to weight gain. an elevated ESR with no improvement in symptoms would indicate the prednisone was not effective but would not be side effects of the medication. an elevated blood glucose is a side effect of prednisone.

the nurse is assessing a patient with osteoarthritis who uses naproxen (Naprosyn) for pain management. which assessment finding would the nurse recognize as likely to require a change in medication? a.the patient has gained 3 pounds. b.the patient has dark-colored stools. c.the patient's pain affects multiple joints. d.the patient uses capsaicin cream (Zostrix).

b. dark-colored stools may indicate the patient is experiencing gastrointestinal bleeding caused by the naproxen. the patient's ongoing pain and weight gain will also be reported and may indicate a need for a different treatment and/or counseling about avoiding weight gain, but these are not as large a concern as the possibility of gastrointestinal bleeding. capsaicin cream is often used along with oral medications.

which result for a patient with systemic lupus erythematosus (SLE) would the nurse identify as most important to communicate to the health care provider? a.decreased C-reactive protein (CRP) b.elevated blood urea nitrogen (BUN) c.positive antinuclear antibodies (ANA) d.positive lupus erythematosus cell prep

b. elevated BUN and serum creatinine indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. the positive lupus erythematosus cell prep and ANA would be expected in a patient with SLE. a drop in CRP shows decreased inflammation.

which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? a."peppermint tea may reduce your symptoms." b."keep the head of your bed elevated on blocks." c."avoid eating between meals to reduce acid secretion." d."vigorous exercise may increase the incidence of reflux."

b. elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. small, frequent meals are recommended to avoid abdominal distention. there is no need to make changes in physical activities because of GERD.

after a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "i cannot manage all this. I don't want to look at the stoma." which action would the nurse take? a.reassure the patient that ileostomy care will become easier. b.ask the patient about the concerns with stoma management. c.postpone any teaching until the patient adjusts to the ileostomy. d.develop a detailed written list of ostomy care tasks for the patient.

b. encouraging the patient to share concerns assists in helping the patient adjust to the body changes. acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance. because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. although detailed ostomy teaching could be postponed, the nurse should begin to offer teaching about some aspects of living with an ostomy.

which action would the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? a.request that the patient stand on one foot. b.ask the patient to extend both arms forward. c.request that the patient walk with eyes closed. d.ask the patient to perform the Valsalva maneuver.

b. extending the arms allows the nurse to check for asterixis, a classic sign of hepatic encephalopathy. the other tests might be done as part of the neurologic assessment but would not be diagnostic for hepatic encephalopathy.

which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of famotidine (Pepcid)? a."famotidine absorbs the excess gastric acid." b."famotidine decreases gastric acid secretion." c."famotidine constricts the blood vessels near the ulcer." d."famotidine covers the ulcer with a protective material."

b. famotidine is a histamine-2 (H2) receptor blocker that decreases the secretion of gastric acid. famotidine does not constrict the blood vessels, absorb the gastric acid, or cover the ulcer.

a young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. the patient asks about the purpose of receiving famotidine (Pepcid). which information would the nurse explain about the action of the medication? a."it decreases nausea and vomiting." b."it inhibits development of stress ulcers." c."it lowers the risk for H. pylori infection." d."it prevents aspiration of gastric contents."

b. famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.

which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? a.restrict fluid intake to prevent constant liquid drainage from the stoma. b.use care when eating high-fiber foods to avoid obstruction of the ileum. c.irrigate the ileostomy daily to avoid having to wear a drainage appliance. d.change the pouch every day to prevent leakage of contents onto the skin.

b. high-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. patients with ileostomies do not have a colon for the absorption of water; they need to take in increased amounts of fluid. the pouch should be drained frequently but is changed every 5 to 7 days. the drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible.

a patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasing abdominal pain. the patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. which nursing action is the highest priority? a.monitor drainage. b.contact the surgeon. c.irrigate the NG tube. d.give prescribed morphine

b. increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion or return to surgery are needed (or both). because the NG is draining, there is no indication that irrigation is needed. continuing to monitor the NG drainage is needed but not an adequate response to the findings. The patient may need morphine, but this is not the highest priority action.

which finding would the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee? a.presence of Heberden's nodules b.discomfort with joint movement c.redness and swelling of the knee joint d.stiffness that increases with movement

b. initial symptoms of OA include pain with joint movement. Heberden's nodules occur on the fingers. redness of the joint is associated with inflammatory arthritis such as rheumatoid arthritis. stiffness in OA is worse right after the patient rests and decreases with joint movement.

the health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. which order would the nurse question? a.draw anti-DNA blood titer. b.administer varicella vaccine. c.naproxen 200 mg twice daily. d.famotidine (Pepcid) 20 mg daily.

b. live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. the other orders are appropriate for the patient.

a 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Considering this treatment, which information would the nurse report to the health care provider? a.the patient had a history of infectious mononucleosis as a teenager. b.the patient is trying to get pregnant before her disease becomes more severe. c.the patient has a family history of age-related macular degeneration of the retina. d.the patient has been using large doses of vitamins and health foods to treat the

b. methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy. the other information will not impact the choice of methotrexate as therapy.

which assessment finding for a 55-yr-old patient would alert the nurse to the presence of osteoporosis? a.bowed legs b.loss of height c.report of frequent falls d.aversion to dairy products

b. osteoporosis occurring in the vertebrae produces a gradual loss of height. bowed legs are associated with osteomalacia and osteoarthritis. low intake of dairy products is a risk factor for osteoporosis, but it does not indicate osteoporosis is present. frequent falls increase the risk for fractures but are not an indicator of osteoporosis.

which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient understands the nurse's teaching about the condition? "i will exercise even if I am tired." "i will use sunscreen when I am outside." "i should avoid nonsteroidal antiinflammatory drugs." "i should take birth control pills to avoid getting pregnant."

b. severe skin reactions can occur in patients with SLE who are exposed to the sun. patients would avoid fatigue by balancing exercise with rest periods as needed. oral contraceptives can exacerbate lupus. aspirin and nonsteroidal antiinflammatory drugs are used to treat the musculoskeletal manifestations of SLE

a patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. what would the nurse teach the patient to avoid? a.emotionally stressful situations b.smoked foods such as ham and bacon c.foods that cause distention or bloating d.chronic use of H2 blocking medications

b. smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. stressful situations, abdominal distention, and use of H2 blockers are not associated with an increased incidence of stomach cancer.

how would the nurse suggest that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day? a.a brief routine of isometric exercises b.a warm shower followed by a short rest c.active range-of-motion (ROM) exercises d.stretching exercises to relieve joint stiffness

b. taking a warm shower or bath is recommended to relieve joint stiffness, which is worse in the morning. isometric exercises would place stress on joints and would not be recommended. stretching and ROM should be done later in the day when joint stiffness is decreased.

which information about dietary management would the nurse include when teaching a patient with peptic ulcer disease (PUD)? a."you will need to remain on a bland diet." b."avoid foods that cause pain after you eat them." c."high-protein foods are least likely to cause pain." d."you should avoid eating raw fruits and vegetables."

b. the best information is that each person should choose foods that are not associated with postprandial discomfort. raw fruits and vegetables may irritate the gastric mucosa but chewing well seems to decrease this problem and some patients tolerate these healthy foods well. high-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. bland diets may be recommended during an acute exacerbation of PUD, but there is little evidence to support their ongoing use.

a nurse is providing teaching for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). the client asks about foods he should avoid eating. which of the following foods should the nurse tell him to avoid a.nonfat milk b.chocolate c.apples d.oatmilk

b. the client should avoid foods that reduce pressure on the lower esophageal sphincter. these include fatty and fried foods, chocolate, caffeine, alcohol, and carbonated drinks.

which topic is most important for the nurse to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis? a.taking lactulose b.avoiding all alcohol use c.maintaining good nutrition d.using vitamin B supplements

b. the disease progression can be stopped or reversed by alcohol abstinence. the other interventions may be used when cirrhosis becomes more severe to decrease symptoms or complications, but the priority for this patient is to stop the progression of the disease.

a patient has recently been diagnosed with rheumatoid arthritis (RA) The patient, who has two school-age children, tells the nurse that home life is very stressful. which initial response would the nurse make? a."you need to see a family therapist for some help with stress." b."tell me more about the situations that are causing you stress." c."perhaps it would be helpful for your family to be in a support group." d."your family should understand the impact of your rheumatoid arthritis."

b. the initial action by the nurse would be further assessment. the other three responses might be appropriate based on the information the nurse obtains with further assessment.

a patient with a stroke is unconscious and unresponsive to stimuli. after learning that the patient has a history of gastroesophageal reflux disease (GERD), which assessment would the nurse plan to make more frequently than is routine? a.apical pulse b.bowel sounds c.breath sounds d.abdominal girth

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

a patient is being treated for bleeding esophageal varices with balloon tamponade. which nursing action will be included in the plan of care? a.instruct the patient to cough every hour. b.monitor the patient for shortness of breath. c.verify the position of the balloon every 4 hours. d.deflate the gastric balloon if the patient reports nausea.

b. the most common complication of balloon tamponade is aspiration pneumonia. in addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. coughing increases the pressure on the varices and increases the risk for bleeding. balloon position is verified after insertion and does not require further verification. balloons may be deflated briefly every 8 to 12 hours to avoid tissue necrosis, but if only the gastric balloon is deflated, the esophageal balloon may occlude the airway. balloons are not deflated for nausea.

a patient with rheumatoid arthritis (RA) tells the clinic nurse about having chronically dry eyes. which action would the nurse take? a.ask the HCP about discontinuing methotrexate. b.suggest the patient use preservative free artificial tears. c.remind the patient that RA is a chronic health condition. d.teach the patient about adverse effects of the RA medications.

b. the patient's dry eyes are consistent with Sjögren's syndrome, a common manifestation of RA. symptomatic therapy such as artificial tears eyedrops is recommended. dry eyes are not a side effect of methotrexate. a focus on the prognosis for RA is not helpful. the dry eyes are not caused by RA treatment but by the disease itself.

a 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and alopecia. she tells the nurse, "i never leave my house because I hate the way I look." which patient problem would the nurse plan to address? a.activity intolerance b.impaired socialization c.impaired tissue integrity d.impaired communication

b. the patient's statement about not going anywhere because of hating the way he or she looks expresses impaired socialization, an insufficient quantity of humanInteraction, because of embarrassment about the effects of the SLE. activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this. the rash with SLE does not impair tissue integrity. there is no evidence of impaired communication ability for this patient.

which result is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices? a.bilirubin levels b.ammonia levels c.potassium levels d.prothrombin time

b. the protein in the blood in the gastrointestinal tract will be absorbed and may result in an increase in the ammonia level because the liver cannot metabolize protein very well. the prothrombin time, bilirubin, and potassium levels should also be monitored, but they will not be affected by the bleeding episode.

which action would the nurse complete before administering alendronate (Fosamax) to a patient with osteoporosis? a.ask about any leg cramps or hot flashes. b.assist the patient to sit up at the bedside. c.be sure that the patient has recently eaten. d.administer the ordered calcium carbonate.

b. to avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after taking the medication. fosamax should be taken on an empty stomach, not after taking other medications or eating. leg cramps and hot flashes are not side effects of bisphosphonates.

a 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. which patient behavior indicates that the nurse's teaching about skin integrity has been effective? a.the patient uses incontinence briefs to contain loose stools. b.the patient uses witch hazel compresses to soothe irritation. c.the patient asks for antidiarrheal medication after each stool. d.the patient cleans the perianal area with soap after each stool.

b. witch hazel compresses are suggested to reduce anal irritation and discomfort. incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. antidiarrheal medications cannot be given 15 to 20 times a day. the perianal area should be washed with plain water or pH balanced cleanser after each stool.

"a nurse is assessing a client who has cirrhosis. which of the following is an expected finding for this client." a.moist skin b.spider angiomas c.tarry stools d.blood in the urine

b. spider angiomas are lesions with a red center and numerous extensions out like a spider web. this is an expected finding for a client.

which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective? a."i will drink more liquids with my meals." b."i should choose high carbohydrate foods." c."vitamin supplements may prevent anemia." d."persistent heartburn is expected after surgery."

c cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. although peptic ulcer disease may recur, persistent heartburn is not expected after surgery, and the patient should call the health care provider if this occurs. ingestion of liquids with meals is avoided to prevent dumping syndrome. foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome.

which action would the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)? a.instruct the patient to purchase a soft mattress. b.teach the patient to use cool water when bathing. c.encourage the patient to take a nap in the afternoon. d.suggest exercise with light weights several times daily.

c. adequate rest helps decrease the fatigue and pain associated with RA. patients are taught to avoid stressing joints, use warm baths to relieve stiffness, and use a firm mattress. when the disease is stabilized, a physical therapist usually develops a therapeutic exercise program that includes exercises that improve flexibility and strength of affected joints, as well as the patient's general endurance.

which action would the nurse include in the plan of care for a patient who is being admitted with a C. difficile infection? a.teach the patient about proper food storage. b.order a diet without dairy products for the patient. c.place the patient in a private room on contact isolation. d.teach the patient about why antibiotics will not be used.

c. because C. difficile is highly contagious, the patient would be placed in a private room, and contact precautions would be used. there is no need to restrict dairy products for this type of diarrhea. metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and storage do not cause C. difficile.

a patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. which prescribed intervention will the nurse implement first? a.send the patient for a CT scan. b.insert a urinary catheter to drainage. c.infuse metronidazole (Flagyl) 500 mg IV. d.place a nasogastric tube to intermittent low suction.

c. because peritonitis can be fatal if treatment is delayed, the initial action would be to start antibiotic therapy (after any ordered cultures are obtained). the other actions can be done after antibiotic therapy is initiated.

s patient had an abdominal-perineal resection for colon cancer. which action is most important for the nurse to include in the plan of care for the day after surgery? a.teach about a low-residue diet. b.monitor output from the stoma. c.assess the drainage and incision. d.encourage acceptance of the stoma.

c. because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. teaching about diet is best done closer to discharge from the hospital. there will be very little drainage into the colostomy until peristalsis returns. the patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.

a patient who has cirrhosis and esophageal varices is being treated with propranolol. which finding is the best indicator to the nurse that the medication has been effective? a.the patient reports no chest pain. b.blood pressure is 130/80 mm Hg. c.stools test negative for occult blood. d.the apical pulse rate is 68 beats/min.

c. because the purpose of b-blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.

a patient is taking methotrexate to treat rheumatoid arthritis (RA). which laboratory result is important for the nurse to communicate to the health care provider? a.rheumatoid factor is positive. b.fasting blood glucose is 90 mg/dL. c.the white blood cell count is 1500/L. d.the erythrocyte sedimentation rate is increased.

c. bone marrow suppression is a possible side effect of methotrexate, and the patient's low WBC count places the patient at high risk for infection. the elevated erythrocyte sedimentation rate and positive rheumatoid factor are expected in RA. the blood glucose is normal.

after a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching? a.maintain a low-residue diet until the area is healed. b.avoid using any topical preparations on the surgical area. c.take prescribed pain medications before you expect a bowel movement. d.delay having a bowel movement for several days until you are well healed.

c. bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement. a high-residue diet will increase stool bulk and prevent constipation. delay of bowel movements is likely to lead to constipation. topical preparations that provide anesthesia or reduce internal sphincter spasms such as topical lidocaine, 2% diltiazem, and glyceryl trinitrate may be used. warm Sitz baths are used to relieve pain and keep the surgical area clean.

the nurse would anticipate the need to teach a patient who has osteoarthritis (OA) about which medication? a.prednisone b.adalimumab (Humira) c.capsaicin cream (Zostrix) d.sulfasalazine (Azulfidine)

c. capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. the other medications would be used for patients with rheumatoid arthritis.

a patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. which assessment finding is most important for the nurse to address immediately? a.the patient reports 7/10 (0 to 10 scale) abdominal pain. b.the patient is experiencing intermittent waves of nausea. c.the patient has no breath sounds in the left anterior chest. d.the patient has hypoactive bowel sounds in all four quadrants.

c. decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. the nausea and abdominal pain would be addressed, but they are not as high priority as the patient's respiratory status. decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.

when the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. the patient tells the nurse, "my arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." which information would be most important for the nurse to provide? a."methotrexate is less expensive than some of the newer drugs." b."it will take 4-6 weeks to see the therapeutic effects of the methotrexate." c."it is important to start methotrexate early to decrease the extent of joint damage." d."methotrexate is effective and has fewer side effects than some of the other drugs."

c. disease-modifying antirheumatic drugs (DMARDs) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. the other statements are accurate, but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible.

which activity in the care of a patient with a new colostomy could the nurse delegate to assistive personnel (AP)? a.document the appearance of the stoma. b.place a pouching system over the ostomy. c.drain and measure the output from the ostomy. d.check the skin around the stoma for breakdown.

c. draining and measuring the output from the ostomy is included in AP education and scope of practice. the other actions should be implemented by LPNs or RNs.

which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? a.scrambled eggs b.white toast and jam c.oatmeal with cream d.pancakes with syrup

c. during acute exacerbations of IBD, the patient would avoid high-fiber foods such as whole grains. high-fat foods also may cause diarrhea in some patients. the other choices are low residue and would be appropriate for this patient.

which response by the nurse best explains the purpose of propranolol for a patient who was admitted with bleeding esophageal varices? a.the medication will reduce the risk for aspiration. b.the medication will inhibit development of gastric ulcers. c.the medication will prevent irritation of the enlarged veins. d.the medication will decrease nausea and improve the appetite.

c. esophageal varices are dilated submucosal veins. patients with varices who are at risk for bleeding often receive a nonselective -blocker (nadolol, propranolol) to reduce bleeding risk. -Blockers decrease high portal pressure, which decreases the risk for rupture. propranolol does not decrease the risk for peptic ulcers, reduce nausea, or help prevent aspiration pneumonia.

which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? a.chocolate pudding b.glass of low-fat milk c.cherry gelatin with fruit d.peanut butter and jelly sandwich

c. gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. foods such as chocolate are avoided because they lower LES pressure. milk products increase gastric acid secretion. high-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

the nurse teaches a patient with osteoarthritis (OA) of the hip about how to manage the OA. which patient statement a need for additional teaching? a."a shower in the morning will help relieve stiffness." b."i can exercise every day to help maintain joint mobility." c."i will take 1 gram of acetaminophen (Tylenol) every 4 hours." d."i can use a cane to decrease the pressure and pain in my hip joint."

c. no more than 4 g of acetaminophen (1 g every 6 hours) should be taken daily to decrease the risk for liver damage. regular exercise, moist heat, and supportive equipment are recommended for OA management.

a young adult has been admitted to the emergency department with nausea and vomiting. which action could the RN delegate to assistive personnel (AP)? a.auscultate the bowel sounds. b.assess for signs of dehydration. c.assist the patient with oral care. d.ask more questions about the nausea.

c. oral care is included in AP education and scope of practice. the other actions are all assessments that require more education and a higher scope of nursing practice.

a new clinic patient with joint swelling and pain is having diagnostic tests. which test would the nurse identify as specific to systemic lupus erythematosus? a.rheumatoid factor (RF) b.sntinuclear antibody (ANA) c.anti-Smith antibody (Anti-Sm) d.lupus erythematosus (LE) cell prep

c. the anti-Sm is antibody found almost exclusively in SLE. the other blood tests are also used in screening but are not as specific to SLE.

a nurse is teaching a client who has a new prescription for cyclosporine oral solution to treat rheumatoid arthritis. which of the following information should the nurse include in the teaching? a. take the medication between meals b. use a plastic container to mix c. mix with chocolate milk d. take with grapefruit juice

c. the client may combine cyclosporine with milk, chocolate milk, or orange juice to make the medication more palatable

a nurse is providing teaching for a client who has gastroesophageal reflux disease (GERD) about ways to manage his condition. which of the following instructions should the nurse include? a."sleep on your left side" b."drink milk to soothe your stomach" c."eat four small meals each day." d."wait to go to bed for 1 hour after eating"

c. the client should avoid eating large meals because of the pressure it places on the stomach. instead, he should eat 4 to 6 meals per day.

a patient has peptic ulcer disease associated with Helicobacter pylori. which medications will the nurse plan to teach the patient? a.sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol) b.metoclopramide (Reglan), bethanechol, and promethazine c.amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec) d.famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole

c. the drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. the other combinations listed are not included in the protocol for H. pylori infection.

a nurse is teaching a client who has osteoarthritis. which of the following instructions should the nurse include in the teaching? a."apply a heat pack at a temperature below your body temperature" b."elevate the affected joint on large pillows" c."take acetaminophen as the primary medication to treat the pain" d."decrease foods high in purines"

c. the nurse should instruct the client to take acetaminophen to treat osteoarthritis.

a nurse is providing teaching to a client who has a new diagnosis of fibromyalgia. which of the following client statements indicates an understanding of the teaching? a."i should increase my caffeine intake" b."i will take my duloxetine in the morning, so i have more energy to accomplish tasks" c."low-impact aerobics can help reduce episodes of pain" d."a course of chemotherapy should provide a cure"

c. the nurse should reinforce that clients who have fibromyalgia can help reduce pain through regular low-impact aerobics, such as walking, swimming, and biking.

at his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. which action would the nurse teach the patient to take? a.increase the amount of fluid with meals. b.eat foods that are higher in carbohydrates. c.lie down for about 30 minutes after eating. d.drink sugared fluids or eat candy after meals.

c. the patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down for a short rest after eating. increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.

how would the nurse prepare a patient with ascites for paracentesis? a.place the patient on NPO status. b.assist the patient to lie flat in bed. c.ask the patient to empty the bladder. d.position the patient on the right side.

c. the patient should empty the bladder to decrease the risk of bladder perforation during the procedure. the patient would be positioned in Fowler's position and would not be able to lie flat without compromising breathing. because no sedation is required for paracentesis, the patient does not need to be NPO.

a 72-yr-old patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. which assessment finding by the nurse is most important to report to the health care provider? a.skin is dry with tenting and poor turgor. b.patient has not voided for the last 2 hours. c.crackles are heard halfway up the posterior chest. d.patient has had 5 loose stools over the previous 6 hours.

c. the presence of crackles in an older patient receiving IV fluids at a high rate suggests volume overload and a need to reduce the rate of the IV infusion. the other data will be reported but are consistent with the patient's age and diagnosis and do not require a change in the prescribed treatment.

during change-of-shift report, the nurse learns about the following four patients. which patient would the nurse assess first? a.a patient who has compensated cirrhosis and reports anorexia b.a patient with chronic pancreatitis who has gnawing abdominal pain c.a patient with cirrhosis and ascites who has a temperature of 102F (38.8C) shoulder pain d.A patient recovering from a laparoscopic cholecystectomy who has severe

c. this patient's history and fever suggest possible spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. the clinical manifestations for the other patients are consistent with their diagnoses and do not indicate complications are occurring.

a nurse is caring for a client who has Crohn's disease. which of the following food choices would follow the recommended diet for clients who have Cohn's disease? a.vanilla milkshake b.buttered popcorn c.tossed green salad d.toast with jelly

d.

a nurse is teaching a client who is starting to take methotrexate to treat rheumatoid arthritis. which of the following instructions should the nurse include in the teaching? a."avoid eating foods high in vitamin k" b."use an alcohol-based mouthwash after each meal." c."take the medication daily" d."drink at least 2 liters of water daily"

d.

a nurse is completing discharge instructions with a client following an acute onset of gout. which of the following client statements indicates an understanding of the treatment regimen? a."i will closely follow a high-purine diet" b."i will limit my fluid intake to 1 liter per day" c."i will take one aspirin every day" d."

d. ......

which patient seen by the nurse in the outpatient clinic is most likely to need teaching about ways to reduce the risk for osteoarthritis (OA)? a.a 56-yr-old man who has a sedentary office job a.a 38-yr-old man who plays on a summer softball team a.a 38-yr-old woman who is newly diagnosed with diabetes a.a 56-yr-old woman who works on an automotive assembly line

d. OA is more likely to occur in women as a result of estrogen reduction at menopause and in persons whose work involves repetitive movements and lifting. moderate exercise, such as softball, reduces the risk for OA. diabetes is not a risk factor for OA. sedentary work is not a risk factor for OA.

a 40-yr-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. which patient teaching will the nurse provide before discharge? a.soak in Sitz baths several times each day. b.cough 5 times each hour for the next 48 hours. c.avoid using acetaminophen (Tylenol) for pain. d.apply a scrotal support and ice to reduce swelling.

d. a scrotal support and ice are used to reduce edema and pain. coughing will increase pressure on the incision. sitz baths will not relieve pain and would not be of use after this surgery. Acetaminophen can be used for postoperative pain.

which topic would the nurse anticipate teaching to a patient who has a new report of heartburn? a.radionuclide tests b.barium swallow exam c.endoscopy procedures d.proton pump inhibitors

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

what information would the review to evaluate the effectiveness of alendronate (Fosamax) therapy for a patient with Paget's disease? a.oral intake b.grip strength c.hemoglobin level d.alkaline phosphatase

d. bisphosphonate drugs are used to slow bone resorption. Monitor drug effectiveness by regular assessment of alkaline phosphatase. oral intake, hemoglobin level, and grip strength information will be collected by the nurse but will not be used in evaluating the effectiveness of this therapy.

a nurse is planning care for a client who has diverticulitis. which of the following menu selections should the nurse include in the plan? a.turkey sandwich with celery sticks b.sliced ham with green salad c.pork tenderloin with green peas d.grilled chicken breast with white rice

d. both of these are low in fiber which is advised during the inflammation of diverticulitis, a high-fiber diet is indicated.

which topic would the nurse plan to teach to a patient with Crohn's disease who has megaloblastic anemia? a.iron dextran infusions b.oral ferrous sulfate tablets c.routine blood transfusions d.cobalamin (B12) supplements

d. crohn's disease frequently affects the ileum, where absorption of cobalamin occurs. cobalamin must be administered regularly by nasal spray or IM to correct the anemia. iron deficiency does not cause megaloblastic anemia. the patient may need occasional transfusions but not regularly scheduled transfusions.

a nurse is contributing to the plan of care for clients who have rheumatoid arthritis. which of the following plans incorporates integrative health? a.offer NSAIDs and occupational therapy to clients b.monitor c-reactive protein and joint x-rays on clients c.request a referral for surgery and physical therapy for clients d.provide massage therapy and corticosteroid medications to clients

d. integrative health combines complementary therapies and conventional medicine in an integrative manner to treat illness, relieve pain, and promote health

an 80-yr-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. which prescribed medication will the nurse discuss with the health care provider before administration? a.sucralfate (Carafate) b.aluminum hydroxide c.ameprazole (Prilosec) d.metoclopramide (Reglan)

d. metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations. hallucinations are not a side effect of proton pump inhibitors, mucosal protectants, or antacids.

the nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. which information would the nurse discuss with the health care provider for an urgent change in the treatment plan? a.knee crepitation is noted with normal knee range of motion. b.patient reports embarrassment about having Heberden's nodes. c.patient's knee pain while golfing has increased over the last year. d.laboratory results indicate blood urea nitrogen (BUN) is elevated.

d. older patients are at increased risk for renal toxicity caused by nonsteroidal antiinflammatory drugs (NSAIDs) such as naproxen. the other information will be reported to the health care provider but is consistent with the patient's diagnosis of osteoarthritis and will not require an immediate change in the patient's treatment plan.

which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)? a."have you been passing a lot of gas?" b."what foods affect your bowel patterns?" c."do you have any abdominal distention?" d."how long have you had abdominal pain?"

d. one criterion for the diagnosis of irritable bowel syndrome is the presence of abdominal discomfort or pain for at least 3 months. abdominal distention, flatulence, and food intolerance are associated with IBS but are not diagnostic criteria.

which suggestion would the nurse make to a group of women with rheumatoid arthritis (RA) about managing activities of daily living? a.strengthen small hand muscles by wringing out sponges or washcloths. b.protect the knee joints by sleeping with a small pillow under both knees. c.stand rather than sit when performing daily household and yard chores. d.limit the number of exercise repetitions during periods of acute inflammation.

d. patients are advised to avoid repetitious movements and exercises during periods of acute inflammation. sitting during household chores is recommended to decrease stress on joints. wringing water out of sponges would increase joint stress. patients are encouraged to position joints in the extended (neutral) position; sleeping with a pillow behind the knees would decrease the ability of the knee to extend.

a 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia. which information would the nurse explain to the patient? a.with a family history of osteoporosis, there is no way to prevent or slow bone resorption. b.estrogen replacement therapy must be started to prevent rapid progression to osteoporosis. c.continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. d.calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

d. progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing exercise. estrogen replacement therapy is not routinely given to prevent osteoporosis because of increased risk of heart disease as well as breast and uterine cancer. corticosteroid therapy increases the risk for osteoporosis.

which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective? a.pancakes with syrup and bacon b.whole wheat toast and fresh fruit c.egg-white omelet and a half grapefruit d.oatmeal with skim milk and fruit yogurt

d. skim milk and yogurt are high in calcium. the other choices do not contain any high-calcium foods.

the health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. which medication schedule would the nurse teach the patient? a.sucralfate at bedtime and antacids before each meal b.sucralfate and antacids together 30 minutes before meals c.antacids 30 minutes before each dose of sucralfate is taken d.antacids after meals and sucralfate 30 minutes before meals

d. sucralfate is most effective when the pH is low and should not be given with or soon after antacids. antacids are most effective when taken after eating. administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. the other regimens will decrease the effectiveness of the medications.

the home health nurse is making a follow-up visit to a patient recently diagnosed with rheumatoid arthritis (RA). which finding indicates to the nurse that additional patient teaching is needed? a.the patient takes a 2-hour nap each day. b.the patient has been taking 16 aspirins each day. c.the patient sits on a stool while preparing meals. d.the patient sleeps with two pillows under the head.

d. the joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. rest, aspirin, and energy management are appropriate for a patient with RA and indicate teaching has been effective.

which assessment would the nurse perform first for a patient who just vomited bright red blood? a.measuring the quantity of emesis b.palpating the abdomen for distention c.auscultating the chest for breath sounds d.taking the blood pressure (BP) and pulse

d. the nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. the other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume.

a patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. which action would the nurse include in the plan of care? a.refer the patient for hospice services. b.infuse IV fluids through a central line. c.teach the patient about antiemetic therapy. d.offer supplemental feedings between meals.

d. the patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving the response to therapies such as surgery, chemotherapy, or radiation. nausea and vomiting are not common clinical manifestations of stomach cancer. there is no indication that the patient requires hospice or IV fluid infusions.

a patient with cirrhosis has ascites and 4+ edema of the feet and legs. which nursing action will be included in the plan of care? a.restrict daily dietary protein intake. b.reposition the patient every 4 hours. c.perform passive range of motion twice daily. d.place the patient on a pressure-relief mattress.

d. the pressure-relieving mattress will decrease the risk for skin breakdown for this patient. adequate dietary protein intake is necessary in patients with ascites to improve oncotic pressure. repositioning the patient every 4 hours will not be adequate to maintain skin integrity. passive range of motion will not take the pressure off areas such as the sacrum that are vulnerable to breakdown.

how would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn? a."it reduces gastroesophageal reflux by increasing the rate of gastric emptying." b."it neutralizes stomach acid and provides relief of symptoms in a few minutes." c."it coats and protects the lining of the stomach and esophagus from gastric acid." d."it treats gastroesophageal reflux disease by decreasing stomach acid production."

d. the proton pump inhibitors decrease the rate of gastric acid secretion. promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. cryoprotective medications such as sucralfate (Carafate) protect the stomach. antacids neutralize stomach acid and work rapidly.

a patient is transferred from the recovery room to a surgical unit after a transverse colostomy. the nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. which action would the nurse take? a.place ice packs around the stoma. b.notify the surgeon about the stoma. c.monitor the stoma every 30 minutes. d.document stoma assessment findings.

d. the stoma appearance indicates good circulation to the stoma. there is no indication that surgical intervention is needed or that frequent stoma monitoring is required. swelling of the stoma is normal for 2 to 3 weeks after surgery. an ice pack is not needed.

the nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. which information will the nurse include? a.the patient will need to be on bedrest for three days after surgery. b.an ileal-anal reservoir will be surgically created in 8 to 12 weeks. c.the patient will have a temporary colostomy for 6-12 months. d.the site for the stoma will be marked on the abdomen before surgery.

d. a wound, ostomy, continence nurse (WOCN) would select the site where the ostomy will be positioned and mark the abdomen preoperatively. the site would be within the rectus muscle, on a flat surface, and in a place that the patient is able to see. a permanent colostomy is created with this surgery and no further surgery would be planned. the patient will be encouraged to walk the day after surgery.