Med Surge Chapter 41
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
"Avoid foods that cause pain after you eat them."
Vasopressin 0.1 unit/min infusion is prescribed for a patient with acute arterial gastrointestinal (GI) bleeding. The vasopressin label states vasopressin 100 units/250 mL normal saline. How many mL/hr will the nurse infuse?
15
The nurse will anticipate teaching a patient experiencing frequent heartburn about
proton pump inhibitors
Which assessment should the nurse perform first for a patient who just vomited bright red blood?
Taking the blood pressure (BP) and pulse
A 26-yr-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid
smoked foods such as ham and bacon
A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. The nurse will anticipate the need for
administration of nystatin tablets
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take
antacids after meals and sucralfate 30 minutes before meals
When a patient is diagnosed with achalasia, the nurse will teach the patient that
treatment may include endoscopic procedures
A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient's
breath sounds
A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. The highest priority action by the nurse is to
contact the surgeon
The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication
treats gastroesophageal reflux disease by decreasing stomach acid production
An older patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place. The health care provider prescribes 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse
periodically aspirates and tests gastric pH
The nurse will anticipate preparing an older patient who is vomiting "coffee-ground" emesis for
endoscopy
A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). The nurse will explain that the medication will
inhibit development of stress ulcers
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. The nurse will teach the patient to
lie down for about 30 minutes after eating
A patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about
misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa
A 58-yr-old woman who was recently diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response by the nurse is most appropriate?
"Having this new diagnosis must be very hard for you."
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed?
"I eat small meals during the day and have a bedtime snack."
Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
"Keep the head of your bed elevated on blocks."
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?
"Ranitidine decreases gastric acid secretion."
The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states
"The cobalamin injections will prevent me from becoming anemic."
Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective?
"Vitamin supplements may prevent anemia."
After change-of-shift report, which patient should the nurse assess first?
A 60-yr-old patient with nausea and vomiting who has dry mucosa and lethargy
Which patient should the nurse assess first after receiving change-of-shift report?
A patient with esophageal varices who has a blood pressure of 92/58 mm Hg
Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood?
Administer 1 L of lactated Ringer's solution
An adult with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question?
Administer loperamide (Imodium) after each stool
A 53-yr-old male patient with deep partial-thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea?
Administer the prescribed morphine sulfate before dressing changes
A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient?
Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
A young adult been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)?
Assist the patient with oral care
Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa?
Avoid use of cigarettes and smokeless tobacco
A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take?
Check the vital signs
Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective?
Cherry gelatin with fruit
Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?
Elevate the head of the bed to at least 30 degrees
Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting?
Dish of lemon gelatin
A 73-yr-old patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. Which nursing action will be included in the plan of care?
Offer supplemental feedings between meals
A 49-yr-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first?
Infuse normal saline at 250 mL/hr
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?
Metoclopramide (Reglan)
Which action should the nurse in the emergency department anticipate for a young adult patient who has had several episodes of bloody diarrhea?
Obtain a stool specimen for culture
After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease, which patient action indicates that the teaching has been effective?
Patient schedules an appointment for allergy testing
The nurse is caring for a patient who develops watery diarrhea and a fever after prolonged omeprazole (Prilosec) therapy. In which order will the nurse take actions?
Place the patient on contact precautions Assess blood pressure and heart rate Contact the health care provider Assess blood pressure and heart rate
Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?
Red, velvety patches on the buccal mucosa
The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider?
Temperature 102.1°F (38.9°C)
The nurse and a licensed practical/vocational nurse (LPN/LVN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/LVN requires that the nurse intervene?
The LPN/LVN positions the head of the bed in the flat position
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?
The patient has no breath sounds in the left anterior chest
A 58-yr-old patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse?
The patient is lethargic and difficult to arouse
The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider?
The patient's lungs have crackles audible to the midchest
A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about
use of nonsteroidal antiinflammatory drugs (NSAIDs)
