Exam 3 reviewer
The nurse is preparing a client who has chronic pancreatitis about how to prevent exacerbations of the disease. Which health teaching will the nurse include? (Select all that apply.)
"Avoid caffeinated beverages." "Be sure and balance rest with activity." "Avoid alcohol ingestion." "Eat small meals and high-calorie snacks."
The nursing is teaching a client diagnosed with gastroesophageal reflux disease (GERD) who is planning to have an endoscopic radiofrequency (Stretta) procedure. What preprocedure health teaching would the nurse include? (Select all that apply.)
"Avoid taking any NSAIDs like ibuprofen for 10 days before the procedure." "Contact the primary health care provider after the procedure if you have increased pain." Rationale: The client having this procedure does not have an incision and will not require a nasogastric tube (NGT). The client should avoid an NGT placement for at least a month after the procedure. A liquid diet is required for only 24 hours after the procedure and then the client should progress to include soft floods like custard and applesauce.
The nurse is teaching a client about the use of viscous lidocaine for oral pain. What health teaching would the nurse include?
"Be sure to check food temperatures before eating." Rationale: Viscous lidocaine has an anesthetic effect in the oral cavity. Therefore, to promote client safety, the nurse would want to teach the client to check food temperature before eating.
What type of stool softener that well evacuate the entire stool in the colon (watery form)
Cathartics
What is an Asian person oral habit that the will alert the nurse during history assessment that must be intervened?
Chewing tobacco
What are the laboratory values that may decrease in presence of under nourishment?
Cholesterol hemoglobin hematocrit serum albumin thyroxine binding pre-albumin transferrin
What are the common drug medication use for GERD
-omeprazole -esomeprazole ---side-effects Nausea Vitamin B deficiency Diarrhea headaches
What is the type of secondary stomatitis that is common to older adult due to antibiotic?
Albican candida (if over growth CANDIDIASIS)
What is the common complication for LNF
Bleeding and infection (report MD) -101 temp -N/V -pain -Bloating - >65yrs temp of 100 (REPORT MD)
What is barium swallow study contraindication
Blockage or severe problem of swallowing
Antimetabolites (-bine) is used for?
Bone marrow and GI cancer --risk for neutropenia --Prone to (DIAHRREA)
What are the two anti-inflammatory or NSAids drug that can cause rebound inflammation and rebound thrombosis?
Ibuprofen in corticosteroid
What is the priority care for patient who has just undergone chemo radiation and steroid therapy who has no appetite to eat?
Increase hydration
The nurse assesses a client who has chronic pancreatitis. What assessment findings would the nurse expect for this client? (Select all that apply.)
Jaundice, Ascites, Polyuria, Steatorrhea, Polydipsia
A lack of protein quantity and quality in the presence of adequate calorie body weight is more normal and serum protein are low.
Kwashiorkor
What are your nursing intervention for patient who has cirrhosis
-manage fluid volume -Prevent or manage hemorrhage -prevent or manage confusion -manage pruritus
The nurse is teaching a client diagnosed with stomatitis about special mouth care. Which statement by the client indicates a need for further teaching?t
"I will use a more firm toothbrush to keep my mouth clean." Rationale: The client who has stomatitis has oral inflammation which causes discomfort. Therefore, all of these actions help to avoid irritation except for needing to use a soft toothbrush or gauze rather than a firm one.
A client has an external percutaneous transhepatic biliary catheter inserted for a biliary obstruction. What health teaching about catheter care would the nurse provide for the client?
"Position the drainage bag lower than the catheter insertion site."
The nurse is preparing to teach a client with chronic hepatitis B about lamivudine therapy. What health teaching would the nurse include?
"Report any changes in urinary elimination while on this drug."
After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching?
"The best time to take the enzymes is immediately after I have a meal or a snack."
Acute sialadenitis treatment
- Adequate hydration (lemon Juice is ok) - moist heat -Massage - nSAIDs - Hard candies - antibiotics -pain medication and medication that can increase saliva flow
Radiation can dry skin and xerostomia (dry mouth), what is your nursing intervention?
----provide lotion (Aveeno) --- mouth care
A nurse is preparing to administer pantoprazole intravenously to prevent stress ulcers during surgery. What action(s) by the nurse is (are) most appropriate? (Select all that apply.)
---Administer the drug through a separate IV line. ---Infuse pantoprazole using an IV pump. ---Use an in-line IV filter when infusing.
What action(s) by the nurse is (are) appropriate to promote nutrition in a client who had a partial gastrectomy? (Select all that apply.
---Administer vitamin B12 injections. --Ask the primary health care provider about folic acid replacement. --Provide iron supplements for the client. Rationale: After a partial or total gastrectomy, clients are at high risk for anemia due to vitamin B12 deficiency, folic acid deficiency, or iron deficiency. The nurse would provide supplements for all these nutrients. The client does not need enteral feeding or total parenteral nutrition.
What are some teaching for this patient who are receiving chemo drug (confusion)
---avoid alcohol or recreational drug (can cause fall)
What are some nursing intervention that you can teach your patient who has mucositis?
---ice water or ice chips ---frequent mouth assessment and oral hygiene (avoid spicy, acidic and salty food)
What are some nursing intervention you can teach for a patient who has alopecia.
--cooling cap to avoid hair loss --wig (artificial hair) -- teach to avoid direct sunlight, apply sunscreen and cover head
The nurse is teaching a client about risk factors for esophageal cancer. Which risk factors would the nurse include? (Select all that apply.)
-Alcohol intake, Obesity, Smoking, Lack of fresh fruits and vegetables, Untreated GERD
What is a nursing assessment that wall signal gastro-esophageal reflux disease
-morning hoarseness (dysphagia or odynophagia) -dyspepsia (indigestion) -crackles upon auscultation
how to clean patient mouth who has dermatitis after chemotherapy.
-nystatin suspension (swish and spit) - chlorhexidine (Swish and spit) - Troches (lozenges) -treats headaches, yeast, fungal
The nurse is teaching a client about the risk of uncontrolled or untreated client's gastroesophageal reflux disease (GERD). What complication(s) may occur if the GERD is not successfully managed? (Select all that apply.)
-Asthma, Laryngitis, Dental caries, Cardiac disease, Cancer
How to make sure patient SURVIVORSHIP of cancer is high
-Follow up schedule - Anxiety (listen to the patient) - SMOKING cessation - COLONOSCOPY (50yrs older to detect colorectal cancer)
Who are at risk for gastro-esophageal reflux disease (GERD) -no known cause has 31% hereditary?
-obese -overweight
The nurse assesses a client who has possible gastritis. Which assessment finding(s) indicate(s) that the client has chronic gastritis? (Select all that apply.)
-Intolerance of fatty foods -Pernicious anemia Rationale: Intolerance of fatty or spicy foods and pernicious anemia are signs of chronic gastritis. Anorexia and nausea/vomiting can be seen in both conditions. Dyspepsia is seen in acute gastritis.
What is the nursing intervention for MUCOSITIS ( inflamed ulcer)
-Oral care - Avoid mouth wash (glycerin) - Rinse mouth with Normal saline (eat SCRAMBLEd egg) easy to mouth with ulcer
what is the complication to the patient who has PUD that is experiencing sharp epigastric pain that is spread over entire abdomen?
-Peritonitis ( due to development of Perforation)
What are some intervention to help keep a healthy oral cavity?
-Report changing condition -avoid alcohol-based mouthwash -Avoid drugs that can increase inflammation ---(Ibuprofen and corticosteroid)
What sign and symptoms of a patient who is experiencing early dumping syndrome?
-Tachycardia -Syncope
What are the five common on chemo drugs?
-antimetabolites -antimitotic antibiotics -Antimitotics/mitosis inhibitor -Topoisomerase inhibitor (can cause DIARRHEA) -miscellaneous agents
What is a non-surgical management oral cancer?
-aspiration precaution -assess for Dyspnea (wheezing) -auscultation (lower lobe secretion = FINE CRACKLES)
What is a health promotion and maintenance for gastritis
-avoid alcohol, Tobacco -limit food and spices that can cause a gastric distress -balance diet -Regular exercise -Stress reduction technique
What are radiation therapy is side-effect
-dermatitis (skin dryness) - altered taste (loss of apetite) -FATIGUE (that last for several month) -bone marrow suppression ( Can cause Bleeding) -----( low H&H, WBC, RBC, PLATELET)------
What are the group of antibiotic that can treat H. pylori
-erythromycin -amoxicillin -metronidazole
What are the symptoms that are reportable to the doctor for infection of oral cancer
-fever -sweating -sore throat -new sore -Shortness of breath
what are the miscellaneous agent oral chemo drug that are use prophylaxis?
-hydroxyurea (oral) --- (can cause DIARRHEA) -Methotrexate (oral)(can cause BLEEDING IN THE GUT)
What is the signs and symptoms of gastro-esophageal reflux disease.
-hyper-salivation -Dental caries -heartburn -Generalized abdominal pain, nausea and gassy
Nursing intervention after barium study
-increase fluid -If unable to expel Barium, three days report to MD -Stool 1 to 3 days after barium is Chalky and light
Hey what are some health promotion and maintenance for a patient who has GERD?
-limit fried, fatty, spicy and caffeine -set up right for one hour after eating to prevent regurgitation
How to avoid extravasation for an IV drug that is very potent?
-make sure that blood flow is present upon aspiration though the line. (pic line/central line)
what are priority care for patient that are receiving Alkylating agent (can cause renal failure if not properly hydrated)?
2-3L of IV fluid ---note: alkylating agent side effects: N/V, diarrhea, peripheral neuropathy.
How many hours does nutrition screening must be done during hospital admission
24 hours
What is borborygmi? A. loud gurgling abdominal sounds B. projectile vomiting C. severe diarrhea D. sharp abdominal pain
A. loud gurgling abdominal sounds (hyper-peristalsis)
Who has the greatest race in proportion of people that has GERD?
30-39yrs old
What are common sign and symptoms for viral hepatitis
Abdominal pain yellowish sclera (icterus) jaundice
What is some signs and symptoms for chronic bronchitis
Abdominal tenderness Ascites Respiratory compromise\ steatorrhea Weight loss Jaundice dark urine Polyuria, polydipsia, polyphagia
What is the primary risk for chronic pancreatitis
Alcoholism
This is a self- induced of starvation resulting from the fear of fatness even though the patient is underweight this condition is often accompanied by psychiatric diagnosis of body dysmorphic disorder (BDD)?
Anorexia nervosa
What are the drug classification treatment use for peptic ulcer and GERD?
Antiacids Proton pump inhibitor Histamine blocker -inhibit gastric secretion -protects gastric mucussa -Accelerate gastric emptying
What is the chemo drug class that can cause Peripheral Neuropathy?
Antimitotics/mitosis inhibitors
A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be appropriate?
Arrange a dietary consult.
The nurse is caring for a client who is scheduled for paracentesis. Which action is appropriate for the nurse to take?
Assist the client to void before the procedure.
What are complication of gastrectomy that must be reported to MD right away?
Bleeding oozing foul smell discharge
What type of study that will give specific diagnosis for hiatal hernia
Barium swallow study with fluoroscopy
A separate psychiatric diagnosis from bulimia which resembles bulimia nervosa in terms of binge eating episode and it involves a feeling loss of control over the eating behavior but it's not accompanied by purging
Binge eating disorder
This is characterized by episode of binge eating in which the patient in a just a large amount of food in a short time. Followed by purging or self induced vomiting.
Bulimia nervosa
What do you call the VALVE that prevents food from going back up
CARDIA
What do you call an extreme body wasting and malnutrition?
Cachexia (cancer is obstructing the GI tract)
What is the kind of cancer that is very painful once it spreads?
Cancer that is spread into the BONE (Treat with IV MORPHINE)
A nurse participates in a community screening event for oral cancer. What client is the highest priority for referral to a primary health care provider?
Client who smokes and drinks daily. Rationale: Smoking and alcohol exposure create a high risk for this client. Poor oral hygiene is not related to the etiology of cancer but may cause a tumor to go unnoticed. Tanning is a risk factor, but short-term exposure does not have the same risk as daily exposure to tobacco and alcohol.
A nurse knows that job-related risks for developing oral cancer include which occupations? (Select all that apply.)
Coal miner Metal worker Plumber Textile worker
What is the type of therapy that is toxic to the systemic cells that affects or system which put the patient in high risk for infection
Cytotoxic systemic therapy (kills cancer cells and normal cells),
What is the important instruction that must be given to the patient in regards to an anti-diarrheal medication bismuth subsalicylate
DONOT crush
What are sign and symptoms of hypovolemic shock
Decrease BP increase heart rate confusion dizziness syncope lightheadedness
What is the other word of hiatal hernia?
Diaphragmatic Hernia
A client who had a partial gastrectomy 3 days ago begins to experience vertigo, sweating, and tachycardia about 30 minutes after eating breakfast. What postoperative complication would the nurse suspects?
Dumping syndrome Rationale: Dumping syndrome causes autonomic symptoms as food quickly leaves the stomach due to its decreased size after surgery.
What does it mean if the patient have increased emptying
Duodenal ulcer
The nurse is caring for a client diagnosed with probable gastroesophageal reflux disease (GERD). What assessment finding(s) would the nurse expect? (Select all that apply.)
Dyspepsia, Regurgitation, Belching, Coughing Chest discomfort, Dysphagia
What is the gold standard diagnostic tool for gastritis, peptic ulcer and gastric cancer
EGD (esophagogastroduodenoscopy)
The nurse notes that the primary health care provider documented the presence of mucosal erythroplasia in a client. What does the nurses understand that this most likely means for this client?
Early sign of oral cancer Rationale: Mucosal erythroplasia is the earliest sign of oral cancer. It is not a fungal infection, inflammation of the gums, or an obvious tumor
Antitumor antibiotics (-cin) is toxic to the heart and pulmonary, what is priority intervention?
Echocardiogram
What is a red and flat or raise that is precancerous
Erythroplakia (precancerous)
What is hepatitis B sign and symptoms
FATIGUE -limit activity -frequent rest
What kind of tube that are use for patients who need long-term intro feeding
G-tube (not sutured), PEG/J tube (sutured)
What do you call an inflammation of the gastric mucosa that is caused bye long-term use of NSAIDs or H. pylori?
Gastritis
This is the type of leukoplakia that has white patches corrugated or folded in appearance, which is first visible sign of HIV
Hairy leukoplakia (white patches cannot be wipe away)
What is the common side of pancreatic cancer
Head of the pancreas
What are some side effects of Zofran?
Headache (most common) ----administer analgesic (acetamenofen)
What are some complication of ulcers
Hemorrhage (most serious) Perforation Pyloric obstruction Intractable disease
What type of hepatitis do you get in a contaminated water due to shellfish
Hepatitis A
What will the RDN recommend for a meal management with patient with undernutrition
High calorie, nutrient rich foods --milkshake, cheese supplement drink such as boost or ensure, --feeding schedule of six small meals maybe Taylor is better than three large ones
What is the common type diet cause of being overweight or obese
High fat and high cholesterol diet
What is the surgical standard approach for gastro-esophageal reflux disease?
Laparoscopic Nissen fundoplication
What type of stool softener that will help is passage full formed stool?
Laxatives
What is a sign and symptoms of oral cancer?
Lesion that is raised, red and eroded
What do a non-cancerous white patches (cannot be scrape off) known as smoker keratosis?
Leukoplakia (treatment Stop smoking or cryotherapy)
What is the common sites of cancer?
Liver
combination of chronic energy deficit and chronic or acute protein deficiency (Thin, wasting body, and fluid buildup)
Marasmic Kwashiorkor
This is a calorie malnutrition in which body fat and protein are wasted but serum protein are still often preserved?
Marasmus
During an interview, the client tells the nurse that the client has a duodenal ulcer. Which assessment finding would the nurse expect?
Melena
What are some drug therapy that a patient can have to treat or prevent anemia for those who are malnourished
Multivitamins zinc (side effect N/V) iron (side effect constipation)
What is the drug that the patient with uncontrolled hypertension seizure anorexia nervosa or bulimia or alcohol withdrawal that must not take
Naltrexone bupropion
What are some foods that can help gastro-esophageal reflux disease
Oats Brown rice sweet potato deets asparagus green beans broccoli
What is the leading cause of preventable death
Overweight or obese
Which of these client assessment findings is typically associated with oral cancer?
Painless red or raised lesion
What do you call if there is deficiency of all three cellular components of the blood (red cells, white cells, and platelets).
Pancytopenia
What does it mean if the patient have delay emptying?
Peptic ulcer
What is the safest way to administer nutrition for patient who are undernutrition?
Peripheral parenteral nutrition (PPN) (short term)
During physical assessment patient's abdomen is rigid border like with rebound tenderness and pain
Peritonitis
What is stage four cancer means?
Poor prognosis
The nurse is caring for a client who has cirrhosis of the liver. What nursing action is appropriate to help control ascites?
Provide a low-sodium diet.
What is a potential life-threatening complications related to fluid and electrolyte shift during aggressive nutrition rehabilitation of the patient in state of starvation
Re-feeding syndrome
What will you do if a G- tube cannot be moved?
Report to MD right away
What are considered an oncologic emergencies?
Sepsis (Life threatening) ICU Disseminated intravascular calculation -----for a patient who has leukemia and adenocarcinoma usually starts with a small bleeding SIADH (excessive level of ADH producing more water and retaining it) -usually seen with patient who has landed brain cancer Hypercalcemia (metastatic cancer) Superior vena cava syndrome (head sweating)
A client with peptic ulcer disease is in the emergency department and reports gastric pain that has gotten much worse over the last 24 hours. The client's blood pressure when lying down is 112/68 mm Hg and when standing is 98/52 mm Hg. What action by the nurse is most appropriate?
Start a large-bore IV with normal saline. Rationale: This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse would start a large-bore IV with isotonic solution. PPIs are not a treatment for an ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the most appropriate action at this time.
-noncontagious painful chancre sore in the lips -Chancre sore (resolve 2 weeks)
Stomatitis -priority give pain medicine -intervention: brush and floss 2x daily
What is the system that describe the "anatomic extent of cancer"
T- Tumor N- nodes M- metastasis
A client who had minimally invasive bypass gastric surgery 2 days ago reports new-onset of severe abdominal pain. What is the nurse's best action as this time?
Take the client's vital signs.
What is acute sialadenitis
The inflammation of a salivary gland, can be caused by dehydration, infectious agents, irradiation, or immunological disorders.
What is the type of hernia that is ROLLING with sign and symptoms of fullness, breathlessness, and suffocation after eating and its worst when the patient is in recumbent position?
Type 2 Hiatal hernia
he nurse is caring for a client who has been diagnosed with peptic ulcer disease. For which complication would the nurse monitor?
Upper gastrointestinal (GI) bleeding
What is the vitamin supplement that patient to have chronic gastritis may require to have?
Vitamin B-12
What vitamin does the patient needs is the patient have cancer?
Vitamin D supplement
What is the vitamin deficiency and electrolyte imbalances that the patient have if they are diagnosed with liver cirrhosis and ascites?
Vitamin K deficiency hypokalemia
What do use the flash G-tube
Warm water
The nurse is caring for a client who had an open traditional esophagectomy. Which assessment findings would the nurse report immediately to the primary health care provider? (Select all that apply.)
Wound dehiscence, Fever, Tachycardia Rationale: Wound dehiscence is a serious, potentially life-threatening problem that needs immediate attention of the primary health care provider, typically the surgeon. Fever and tachycardia may indicate that the client has a postoperative infection, another serious, potentially life-threatening complication. Indications of both of these problems need to be documented and reported by the nurse. Nausea, fatigue, and moderate pain are expected postoperative assessment findings.
what is the most accurate way to check placement of tube in the initial placement?
XRAY
What medication will the nurse give to the patient that is usually given before chemotherapy start?
Zofran (can cause possible sleepiness) ---given IV or IV peggy back (4-8mg)
What is the major common cause of death in United States
chronic liver disease and cirrhosis
what is anti-rejection drug use for liver transplantation?
cyclosporine
What is the most common sites of metastasis?
lung
What type of hernia that have a SLIDING and has signs and symptoms of chest pain or heartburn?
type 1 Hiatal hernia