MedSurg 2 Final

Different ways to deal with active bleeding to prevent rebleeding

- NGT - Endoscopic therapy - IR procedures - Acid suppression by PPI or H2.

Interventions for Acute GI bleed and S/S of deterioration

*IV proton pump inhibitors (PPIs) such as Omeprazole/Prilosec to suppress acid* Emergency: Upper GI Bleeding: life-threatening emergency *Respond to these needs by providing oxygen and other ventilatory support as needed, starting two large-bore IV lines for replacing fluids and blood, and monitoring vital signs, hematocrit, and oxygen saturation* Older adults: *closely monitor for fluid overload*. Common volume replacement: 1. 0.9% NS 2. Lactated Ringer's solution *start immediately* *Frozen fresh plasma if PPT is 1.5 higher than the midrange control value*

Misoprostol for Rheumatoid Arthritis

4. Misoprostol for Rheumatoid Arthritis •Misoprostol/Cytotec = Prostaglandin Analogs - stimulate mucosal protection and decrease gastric acid secretion • Most commonly used to treat GI bleeds caused by ulcers / gastritis o Avoid magnesium-containing antacids: Misoprostol and magnesium-containing antacids can cause diarrhea o Do not administer to pregnant women: This drug can cause abortion, premature birth, or birth defects o Common examples of drug therapy for Peptic Ulcer Disease Misoprostol is a synthetic (man-made) prostaglandin that is used to reduce the risk of stomach ulcers in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs, for example, aspirin, ibuprofen, etc.) that are used for pain and various inflammatory conditions, for example, arthritis.

A patient has been diagnosed with mild GERD and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this patient? A. Avoid caffeine-containing foods and beverages. B. Eat 3 meals each day and avoid snacking between meals C. Peppermint lozenges help to reduce stomach upset D. Sleep on your left side with pillow between your legs.

A

After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL

A Rationale: Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The dyspneic client is at greatest risk for rapid deterioration and requires immediate assessment and intervention. The client with cholecystitis and the client with an elevated temperature will require further assessment and intervention, but these are not medical emergencies requiring the nurse's immediate attention. The older adult client's glucose level will require intervention but, again, is not a medical emergency.

A patient is experiencing bleeding r/t PUD. Which nursing intervention is highest priority? A. Starting a large-bore IV B. Administering IV pain medication C. Preparing equipment for intubation D. Monitoring the patient's anxiety level

A Rationale: A/ A large-bore IV is inserted so that blood products can be administered. (Rationale)

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

A. A simple change in positioning during intercourse may alleviate the client's apprehension and facilitate sexual relations with his wife. Suggesting marriage counseling may address the client's concerns, but it focuses on the wrong issue; the client has not stated that he has relationship problems. Asking the client what his wife has said about the pouch may address the client's concerns, but it similarly focuses on the wrong issue. Telling the client that he needs to get clearance from his health care provider is an evasive response that does not address the client's primary concern.

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

A. For less severe exacerbations, an elemental or semi-elemental product such as Vivonex PLUS may be prescribed to induce remission. These products are absorbed in the jejunum and therefore permit the distal small intestine and colon to rest. Nutritional supplements such as Ensure or Sustacal are added to provide nutrients and more calories. GI stimulants such as caffeinated beverages and alcohol should be avoided, but this is not the reason for using Vivonex PLUS.

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

A. The client should avoid being around large crowds to prevent developing an infection. The client should not take the medication if he or she is allergic to certain proteins. *Although immune suppression may occur to some degree, the client should not experience difficulty with wound healing while taking adalimumab. *The client should not experience a decrease in blood pressure from taking this drug

The nurse knows the patient with AKI has entered the diuretic phase when what assessments occur (select all that apply)? A.Dehydration B.Hypokalemia C.Hypernatrimia D.BUN increases E.Serum Creatinine Increases

AB Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Therefore the serum BUN and serum creatinine levels also begin to decrease.

The nurse is caring for an older adult client who experiences an exacerbation of ulcerative colitis with severe diarrhea that have lasted a week. For which complications will the nurse assess? Select all that apply: A. Dehydration B. Hypokalemia C. Skin breakdown D. Deep vein thrombus E. Hyperkalemia

ABC

A nurse teaches a client about self-care after experiencing a urinary calculus treated by lithotripsy. Which statements should the nurse include in this clients discharge teaching? (Select all that apply.) a. Finish the prescribed antibiotic even if you are feeling better. b. Drink at least 3 liters of fluid each day. c. The bruising on your back may take several weeks to resolve d. Report any blood present in your urine. e. It is normal to experience pain and difficulty urinating.

ABC The client should be taught to finish the prescribed antibiotic to ensure that he or she does not get a urinary tract infection. The client should drink at least 3 liters of fluid daily to dilute potential stoneforming crystals, prevent dehydration, and promote urine flow. After lithotripsy, the client should expect bruising that may take several weeks to resolve. The client should also experience blood in the urine for several days. The client should report any pain, fever, chills, or difficulty with urination to the provider as these may signal the beginning of an infection or the formation of another stone.

Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply: A. Thrombocytopenia B. Vision changes C. Increased PT/INR D. Leukopenia

ACD A prolonged PT means that the blood is taking too long to form a clot. This may be caused by conditions such as liver disease, vitamin K deficiency, or a coagulation factor deficiency (e.g., factor VII deficiency).

The client is six (6) hours postoperative open cholecystectomy and the nurse finds a large amount of red drainage on the dressing. Which intervention should the nurse implement? 1. Measure the abdominal girth. 2. Palpate the lower abdomen for a mass. 3. Turn client onto side to assess for further drainage. 4. Remove the dressing to determine the source

ANS: 3. Turn client onto side to assess for further drainage

Which problem is highest priority for the nurse to identify in the client who had an open cholecystectomy surgery? 1. Alteration in nutrition 2. Alteration in skin integrity 3. Alteration in urinary pattern 4. Alteration in comfort

ANS: 4. Acute pain management is the highest priority client problem after surgery because pain may indicate a life-threatening problem

The client is four (4) hours postoperative open cholecystectomy. Which data would warrant immediate intervention by the nurse? 1. Absent bowel sounds in all four (4) quadrants. 2. The T-tube with 60 mL of green drainage. 3. Urine output of 100 mL in the past three (3) hours. 4. Refusal to turn, deep breathe, and cough.

ANS: 4. Refusal to turn, deep breathe, and cough Rationale: Refusing to turn, deep breathe, and cough puts the client at risk for pneumonia. This client needs immediate intervention to prevent complications.

Which nursing action is of highest priority for a 68-year-old patient with renal calculi who is being admitted to the hospital with gross hematuria and severe colicky left flank pain? a. Administer prescribed analgesics. b. Monitor temperature every 4 hours. c. Encourage increased oral fluid intake. d. Give antiemetics as needed for nausea.

ANS: A Although all of the nursing actions may be used for patients with renal lithiasis, the patient's presentation indicates that management of pain is the highest priority action. If the patient has urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of infection or nausea.

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? A. Increased blood urea nitrogen (BUN) B. Increased creatinine level C. Pale-colored urine D. Decreased sodium level

ANS: A. Increased BUN An increase in BUN can be an indication of dehydration, and an increase in fluids is needed. Increased creatinine indicates kidney impairment. Urine that is pale in color is diluted; an increase in fluids is not necessary. Sodium is increased, not decreased, with dehydration.

What is the nurse's priority when changing the appliance for a patient with an ileal conduit? A. Keep the skin free of urine. B. Inspect the peristomal area. C. Cleanse and dry the area gently. D. Affix the appliance to the faceplate.

ANS: A. Keep the skin free of urine The nurse's priority is to keep the skin free of urine because the peristomal skin is at high risk for damage from the urine if it is alkaline. The peristomal area will be assessed; the area will be gently cleaned and dried, and the appliance will be affixed to the faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage.

The healthcare provider is assessing a patient diagnosed with ulcerative colitis. The patient has an altered level of consciousness, fever, and lower abdominal distension. Which of these additional findings would confirm a diagnosis of toxic megacolon? A. Leukocytosis B. Bradycardia C. Constipation D. Splenomegaly

ANS: A. Leukocytosis Rationale: Toxic megacolon occurs in inflammatory bowel disease either as a result of inflammatory flare-up or infection. The abdomen expands and is unable to remove gas and feces, which then build up. The increased abdominal pressure can cause the colon to rupture.

During an acute exacerbation of inflammatory bowel disease, a patient is to receive total parenteral nutrition (TPN) and lipids. Which of these interventions is the priority when caring for this patient? a. Monitor the patient's blood glucose per protocol b. Infuse the solution in a large peripheral vein c. Change the administration set every 72 hours d. Monitor urine specific gravity every shift

ANS: A. Monitor the patient's blood glucose per protocol

A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take? a. Place the patient on a cardiac monitor. b. Check the patient's blood pressure (BP). c. Instruct the patient to avoid high-potassium foods. d. Call the lab and request a redraw of the lab to verify results.

ANS: A. Place the patient on a cardiac monitor

The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) A. Restricted protein B. Liberal sodium C. Restricted fluids D. Low potassium E. Low fat

ANS: ACD Restricted protein Correct Restricted fluids Correct Low potassium Correct Breakdown of protein leads to azotemia and increased blood urea nitrogen. *Fluid is restricted during the oliguric stage. *Potassium intoxication may occur, so dietary potassium is also restricted. Sodium is restricted during AKI because oliguria causes fluid retention. Fats may be used for needed calories when proteins are restricted.

A patient with renal calculi is hospitalized with gross hematuria and severe colicky left flank pain. Which nursing action will be of highest priority at this time? a. Encourage oral fluid intake. b. Administer prescribed analgesics. c. Monitor temperature every 4 hours. d. Give antiemetics as needed for nausea.

ANS: B Although all of the nursing actions may be used for patients with renal lithiasis, the patient's presentation indicates that management of pain is the highest priority action. If the patient has urinary obstruction, increasing oral fluids may increase the symptoms. There is no evidence of infection or nausea.

Which information given by a 70-year-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a. The patient had a blood transfusion in 2005. b. The patient used IV drugs about 20 years ago. c. The patient frequently eats in fast-food restaurants. d. The patient traveled to a country with poor sanitation

ANS: B Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions given after 1992 (when an antibody test for hepatitis C became available) do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by contaminated food or by traveling in underdeveloped countries.

How will the nurse assess for flank tenderness in a 30-year-old female patient with suspected pyelonephritis? a. Palpate along both sides of the lumbar vertebral column. b. Strike a flat hand covering the costovertebral angle (CVA). c. Push fingers upward into the two lowest intercostal spaces. d. Percuss between the iliac crest and ribs along the midaxillary line.

ANS: B Checking for flank pain is best performed by percussion of the CVA and asking about pain. The other techniques would not assess for flank pain.

A 22-year-old female patient seen in the clinic for a bladder infection describes the following symptoms. Which information is most important for the nurse to report to the health care provider? a. Urinary urgency b. Left-sided flank pain c. Intermittent hematuria d. Burning with urination

ANS: B Flank pain indicates that the patient may have developed pyelonephritis as a complication of the bladder infection. The other clinical manifestations are consistent with a lower urinary tract infection (UTI).

When caring for a dehydrated patient with acute kidney injury who is oliguric, anemic, and hyperkalemic, which of the following prescribed actions should the nurse take first? a. insert a urinary retention catheter b. place the pt on a cardiac monitor c. administer epoetin alfa (epogen, procrit) d. give sodium polystyrene sulfonate (Kayexalate)

ANS: B Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output, but does not correct the cause of the renal failure.

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix). due. Which action should the nurse take? a. Administer both drugs. b. Administer the spironolactone. c. Withhold the spironolactone and administer the furosemide. d. Withhold both drugs until discussed with the health care provider

ANS: B Spironolactone is a potassium-sparing diuretic and will help increase the patient's potassium level. The nurse does not need to talk with the doctor before giving the spironolactone, although the health care provider should be notified about the low potassium value. The furosemide will further decrease the patient's potassium level and should be held until the nurse talks with the health care provider.

A patient with peptic ulcer disease associated with the presence of Helicobacter pylori is treated with triple drug therapy. The nurse will plan to teach the patient about a. sucralfate (Carafate), nystatin (Mycostatin), and bismuth (Pepto-Bismol). b. amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec). c. famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix). d. metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan).

ANS: B 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.

When the nurse is caring for a patient who has been admitted with a severe crushing injury after an industrial accident, which laboratory result will be most important to report to the health care provider? a. serum creatinine level 2.1 mg/dL b. serum potassium level 6.5 mEq/L c. WBC 11,500/uL d. BUN 56 mg/dL

ANS: B The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse also will report the other laboratory values, but abnormalities in these are not immediately life threatening.

A 53-year-old 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

ANS: 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. The esophageal balloon is deflated every 8 to 12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.

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

ANS: B The protein in the blood in the gastrointestinal (GI) 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.

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

ANS: B The protein in the blood in the gastrointestinal (GI) 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.

A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the clients right lower back. Which action should the nurse take? a. Administer fresh-frozen plasma. b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results.

ANS: B The shock waves from lithotripsy can cause bleeding into the tissues through which the waves pass. Application of ice can reduce the extent and discomfort of the bruising. Although coagulation test results and fresh-frozen plasma are used to assess and treat bleeding disorders, ecchymosis after this procedure is not unusual and does not warrant a higher level of intervention. Changing the clients position will not decrease bleeding.

Which assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis? A. The patient s urine is bright yellow. B. The patient s stools are tan colored. C. The patient has increased pain after eating. D. The patient complains of chronic heartburn.

ANS: B. Rationale: Tan or gray stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, although the nurse would also report the other assessment information to the health care provider

The nurse is caring for a patient who complains of abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient is experiencing a decline in condition? A. Ecchymoti peripheral IV site B. Heart rate 110. respiratory rate 26, BP 90/55 C. Guaiac-positive diarrhea stools D. Nausea

ANS: B. Heart rate 110, respiratory rate 26, BP 90/55 (hypovolemic shock)

A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about A. substitution of acetaminophen (Tylenol) for the NSAID B. misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa C. reasons for using corticosteroids to treat the rheumatoid arthritis D. use of enteric-coated NSAIDs to reduce gastric irritation

ANS: B. Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa

A patient diagnosed with ulcerative colitis is admitted to the medical unit. When assessing the patient, which of these findings would be of the most concern? A. Oral temperature of 99.0 F (37.2 C) B. Rebound tenderness C. Bloody diarrhea D. Borborygmi

ANS: B. Rebound tenderness Rationale: While bloody diarrhea is associated with ulcerative colitis and should be included in the patient's plan of care, rebound tenderness is more concerning because it could indicate peritonitis or another form of infection

A 68-year-old man with a history of heart failure resulting from hypertension has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2 mEq/L (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4.1 mg/dL (362 mmol/L), and his serum HCO3- is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. Loop diuretics b. Renal replacement therapy c. Insulin and sodium bicarbonate d. Sodium polystyrene sulfonate (Kayexalate)

ANS: B. Renal replacement therapy

Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient 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.

ANS: C *Esophageal varices are dilated submucosal veins. The therapeutic action of H2-receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents. *Although ranitidine does decrease the risk for peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, these are not the primary purposes for H2-receptor blockade in this patient.

A client reports ongoing episodes of heartburn. The nurse educates the client on prevention and control of reflux by recommending dietary elimination of which food item? a. Lean steak b. Carrot sticks c. Chocolate candy d. Air-popped popcorn

ANS: C Foods that decrease esophageal sphincter pressure, such as fatty food, caffeine, and chocolate, should be avoided.

A 64-year-old male patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis. b. Unlimited fluids are allowed because retained fluid is removed during dialysis. c. More protein is allowed because urea and creatinine are removed by dialysis. d. Dietary potassium is not restricted because the level is normalized by dialysis.

ANS: C Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately.

ANS: C The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign. The health care provider should be notified after the nurse checks the patient's calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.

A nurse assesses a client with bladder cancer who is recovering from a complete cystectomy with ileal conduit. Which assessment finding should alert the nurse to urgently contact the health care provider? a. The ileostomy is draining blood-tinged urine. b. There is serous sanguineous drainage present on the surgical dressing. c. The ileostomy stoma is pale and cyanotic in appearance. d. Oxygen saturations are 92% on room air.

ANS: C. Rationale: A pale or cyanotic stoma indicates impaired circulation to the stoma and must be treated to prevent necrosis. Blood-tinged urine and serous sanguineous drainage are expected after this type of surgery. Oxygen saturation of 92% on room air is at the low limit of normal.

The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? A. Deceased calcium, elevated amylase, decreased magnesium B. Elevated bilirubin, elevated alkaline phosphatase C. Elevated lipase, elevated white blood cell (WBC) count, elevated glucose D. Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

ANS: C. Rationale: Elevated lipase, along with increased WBC and increased glucose, suggests acute pancreatitis. Also, increased are serum amylase, serum trypsin, and serum elastase.Many pancreatic and nonpancreatic disorders can cause increased serum amylase levels. Bilirubin and alkaline phosphatase levels will be increased only if pancreatitis is accompanied by biliary dysfunction. Usually, calcium and magnesium will be increased and BUN increased, not decreased, in acute pancreatitis.

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? A. "I can have a glass of low-fat milk at bedtime." B. "I will have to eliminate all spicy foods from my diet." C. "I will have to use herbal teas instead of caffeinated drinks." D. "I should keep something in my stomach all the time to neutralize the excess acids."

ANS: C. "I will have to use herbal teas instead of caffeinated drinks." Rationale: Patients with GERD should avoid all forms of caffeine. In addition, they should avoid eating before bedtime. Therefore, a patient should not drink a glass of milk before bed or keep something in their stomach at all times. A patient should generally avoid spicy foods, but only ones that cause discomfort.

The healthcare provider is teaching a patient diagnosed with Crohn's disease who is recovering from a bowel resection. Which of the following statements made by the patient indicates the teaching has been effective? A. "Now that the bowel has been removed, the disease is cured." B. "Now I can discontinue taking my multivitamin supplements." C. "The disease might reappear in another part of the bowel." D. "I might develop ulcerative colitis because some of my bowel is missing."

ANS: C. "The disease might reappear in another part of the bowel." Rationale: Crohn's disease is an immune-related disease, which means that removing a highly effect part of the bowel is not curative, because it does not eradicate the source. While it will provide relief of symptoms, lesions may end up affecting another area of the bowel

A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator that the medication has been effective? a. The patient reports no chest pain. b. Blood pressure is 140/90 mm Hg. c. Stools test negative for occult blood. d. The apical pulse rate is 68 beats/minute.

ANS: C. *Stools test negative for occul blood Because the purpose of β-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.

The nurse is reviewing the medication history for a patient diagnosed with gastroesophageal reflux disease (GERD) who has been prescribed esomeprazole (Nexium) once daily. The patient reports that this proton pump inhibitor medication doesn t completely control the symptoms. The nurse contacts the primary health care provider to discuss which intervention? A. Adding a second proton pump inhibitor medication B. Increasing the dose of esomeprazole C. Changing to a twice-daily dosing regimen D. Switching to omeprazole (Prilosec)

ANS: C. Changing to a twice-daily dosing regimen

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

ANS: C. Obtain pulse and blood pressure. The nurse should assess vital signs to detect hypovolemic shock caused by hemorrhage. Obtaining charts, assessing bowel sounds, and pain assessment can be delayed until the client has stabilized. Assessment for adequate perfusion is the highest priority at this time.

The home health nurse is planning to make a home visit to a client who has undergone surgical creation of an ileal conduit. The nurse should include which information on ostomy care in discussion with the client?

ANS: Cleanse the skin around the stoma, using gentle soap and water, and then rinse and dry well.

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for: a. vasodilation. b. poor skin turgor. c. bounding pulses. d. rapid respirations.

ANS: D Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI.

Which assessment finding is most important to report to the health care provider regarding a patient who has had left-sided extracorporeal shock wave lithotripsy? a. Blood in urine b. Left flank bruising c. Left flank discomfort d. Decreased urine output

ANS: D Because lithotripsy breaks the stone into small sand, which could cause obstruction, it is important to report a drop in urine output. Left flank pain, bruising, and hematuria are common after lithotripsy.

Which finding by the nurse will be most helpful in determining whether a 67-year-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)? a. Bladder distention b. Foul-smelling urine c. Suprapubic discomfort d. Costovertebral tenderness

ANS: D Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention, foul-smelling urine, and suprapubic discomfort are characteristic of lower UTI and are likely to be present if the patient also has an upper UTI.

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Abdominal tenderness and guarding d. Muscle twitching and finger numbness

ANS: D Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered. Although the other findings should also be reported to the health care provider, they do not indicate complications that require rapid action

A 51-year-old woman had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to a. choose low-fat foods from the menu. b. perform leg exercises hourly while awake. c. ambulate the evening of the operative day. d. turn, cough, and deep breathe every 2 hours.

ANS: D Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions are also important to implement but are not as high a priority as ensuring adequate ventilation.

Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective? a. Increased serum albumin level b. Decreased indirect bilirubin level c. Improved alertness and orientation d. Fewer episodes of bleeding varices

ANS: D TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by shunting procedures. TIPS will increase the risk for hepatic encephalopathy.

Which data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis? a. Hemoglobin b. Temperature c. Activity level d. Albumin level

ANS: D The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters should also be monitored, but they are not directly associated with the patient's current symptoms.

Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)? A. "Peppermint tea may reduce your symptoms." B. "You should avoid eating between meals to reduce acid secretion." C. "Vigorous physical activities may increase the incidence of reflux." D. "Keep the head of your bed elevated on blocks."

ANS: D. "Keep the head of your bed elevated on blocks"

Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood? A. give an IV H2 antagonist B. Call the blood bank C. Insert a nasogastric (NG) tube and connect to suction D. Administer 1 L of Lactated Ringer's solution

ANS: D. Administer 1L of Lactated Ringer's solution

A nurse cares for a client who is scheduled for the surgical creation of an ileal conduit. The client states, I am anxious about having an ileal conduit. What is it like to have this drainage tube? How should the nurse respond? a. I will ask the provider to prescribe you an antianxiety medication. b. Would you like to discuss the procedure with your doctor once more? c. I think it would be nice to not have to worry about finding a bathroom. d. Would you like to speak with someone who has an ileal conduit?

ANS: D. Rationale: The goal for the client who is scheduled to undergo a procedure such as an ileal conduit is to have a positive self-image and a positive attitude about his or her body. Discussing the procedure candidly with someone who has undergone the same procedure will foster such feelings, especially when the current client has an opportunity to ask questions and voice concerns to someone with first-hand knowledge. Medications for anxiety will not promote a positive self-image and a positive attitude, nor will discussing the procedure once more with the physician or hearing the nurses opinion.

In a patient with AKI, which laboratory urinalysis result indicates tubular damage? a. Hematuria b. Specific gravity fixed at 1.010 c. Urine sodium of 12 mEq/L (12 mmol/L) d. Osmolality of 1000 mOsm/kg (1000 mmol/kg)

ANS: b. *A urine specific gravity that is consistently 1.010 and a urine osmolality of about 300 mOsm/kg is the same specific gravity and osmolality as plasma. This indicates that tubules are damaged and unable to concentrate urine.* Hematuria is more common with postrenal damage. Tubular damage is associated with a high sodium concentration (greater than 40 mEq/L).

A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L) and the following arterial blood gas results: pH 7.28, PaCO2 30 mm Hg, PaO2 86 mm Hg, HCO3− 18 mEq/L (18 mmol/L). The nurse recognizes that treatment of the acid-base problem with sodium bicarbonate would cause a decrease in which value? a. pH b. Potassium level c. Bicarbonate level d. Carbon dioxide level

ANS: b. During acidosis, potassium moves out of the cell in exchange for H+ ions, increasing the serum potassium level. Correction of the acidosis with sodium bicarbonate will help to shift the potassium back into the cells. A decrease in pH and the bicarbonate and PaCO2 levels would indicate worsening acidosis.

A 52-year-old patient is scheduled to undergo ileal conduit surgery. When planning this patient's discharge education, what is the most plausible nursing diagnosis that the nurse should address? A) Impaired mobility related to limitations posed by the ileal conduit B) Deficient knowledge related to care of the ileal conduit C) Risk for deficient fluid volume related to urinary diversion D) Risk for autonomic dysreflexia related to disruption of the sacral plexus

Ans: B Rationale: The patient will most likely require extensive teaching about the care and maintenance of a new urinary diversion. A diversion does not create a serious risk of fluid volume deficit. Mobility is unlikely to be impaired after the immediate postsurgical recovery. The sacral plexus is not threatened by the creation of a urinary diversion.

While caring for a patient with an acute kidney injury, the patient complains of severe weakness and palpitations. The electrocardiogram reveals widening of the QRS complex and an elevated T wave. What complication does the nurse suspect in this patient? 1. Hyperkalemia 2 Hypercalcemia 3 Hypernatremia 4 Hyperchloremia

Answer: 1 Hyperkalemia is associated with electrocardiographic changes like T-wave elevation, widening of the QRS complex, and ST-segment depression. A short QT interval and a small ST segment indicate hypercalcemia. Hypernatremia is characterized by a flat T wave. A depressed T wave is a characteristic of hyperchloremia.

A 51-year-old male patient has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months. The nurse will plan to teach about a. medication use. b. fluid restriction. c. enteral nutrition. d. activity restrictions.

Answer: A

A 51-year-old woman 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

Answer: A

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to a. administer IV metoclopramide (Reglan). b. discontinue the patient's oral food intake. c. administer cobalamin (vitamin B12) injections. d. teach the patient about total colectomy surgery

Answer: B Rationale (I found on pg 1153 Iggy): Patients with severe symptoms who are hospitalized are kept NPO to ensure bowel rest. The physician may prescribe total parenteral NUTRITION (TPN) for severely ill and malnourished patients during severe exacerbations

A 22-year-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 teaching regarding maintenance of skin integrity has been effective? a. The patient uses incontinence briefs to contain loose stools. b. The patient asks for antidiarrheal medication after each stool. c. The patient uses witch hazel compresses to decrease irritation. d. The patient cleans the perianal area with soap after each stool.

Answer: C

A 72-year-old male 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. Patient has not voided for the last 4 hours. b. Skin is dry with poor turgor on all extremities. c. Crackles are heard halfway up the posterior chest. d. Patient has had 5 loose stools over the last 6 hours.

Answer: C

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? a Antibiotic(s), antacid, and corticosteroid b Antibiotic(s), aspirin, and antiulcer/protectant c Antibiotic(s), proton pump inhibitor, and bismuth d Antibiotic(s) and nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer: C To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

The nurse is assessing a patient with acute cholecystitis whose abdominal pain is severe. The patient is pale, is diaphoretic, and describes extreme fatigue. Vital signs are: heart rate of 118/minute, BP 95/70, respirations 32/min, temperature 101F. What is the nurse's priority action at this time? A. Instruct the unlicensed assistive personnel (UAP) to reposition the patient for comfort B. Auscultate the patient's abdomen in all four quadrants C. Notify the healthcare provider D. Administer the ordered opioid analgesics

Answer: C, d/t possible shock

The nurse closely monitors the client with acute pancreatitis for which life-threatening complication? A. Jaundice B. Type I diabetes C. Abdominal pain D. Disseminated intravascular coagulation (DIC)

Answer: D

The nurse cares for a patient complaining of sudden onset of severe right flank pain. The patient is diagnosed with urinary calculi. Which of the following nursing actions has the HIGHEST priority? a) Ensure that the patient remain NOP b) Strain all urine through several layers of gauze c) Assess the patient's grip strength and pupil reactivity d) Obtain a clean-catch urine specimen

Answer: b) Strain all urine through several layers of gauze. Urine should be strained to collect any stones that may be passed so that they can be analyzed for composition

During discharge instructions for a patient following a laparoscopic cholecystectomy, the nurse advises the patient to a. keep the incision areas clean and dry for at least a week b. report the need to take pain medication for shoulder pain c. report any bile colored or purulent drainage from the incisions d. expect some postoperative nausea and vomiting for a few days

Answer: c. report any bile colored or purulent drainage from the incisions

When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? (Select all that apply.) A. Prolonged partial thromboplastin time B. Icterus of skin C. Swollen abdomen D. Elevated magnesium E. Currant jelly stool F. Elevated amylase level

Answers: ABC The liver produces clotting factors; when it is damaged, prolonged coagulation times and bleeding may result. Icterus, or jaundice, results from cirrhosis. The client with cirrhosis may develop ascites, or fluid in the abdominal cavity. Elevated magnesium is not related to cirrhosis. The client with cirrhosis may develop hypocalcemia and/or hypokalemia. Currant jelly stool is consistent with intussusception, a type of bowel obstruction. Cirrhosis is consistent with elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase; amylase is typically elevated in pancreatitis.

A 54-yr-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. Which diagnosis does the nurse expect? A. Starvation B. Pancreatitis C. Systemic sepsis D. Diabetic ketoacidosis

B

A 56-year-old female patient is admitted to the hospital with new onset nephrotic syndrome. Which assessment data will the nurse expect? a. Poor skin turgor b. Recent weight gain c. Elevated urine ketones d. Decreased blood pressure

B The patient with a nephrotic syndrome will have weight gain associated with edema. Hypertension is a clinical manifestation of nephrotic syndrome. Skin turgor is normal because of the edema. Urine protein is high.

What is the most serious electrolyte disorder associated with kidney disease? a. Hypocalcemia b. Hyperkalemia c. Hyponatremia d. Hypermagnesemia

B In AKI the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.

A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority instruction for this client to avoid further attacks of pancreatitis? A. "You may need a surgical consult for removal of your gallbladder." B. "See your health care provider immediately when experiencing symptoms of a gallbladder attack." C. "If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider." D. "You'll need to drastically modify your alcohol intake."

B Rationale: In this case, the client's pancreatitis was likely triggered by the development of gallstones. A diagnostic statement must come from the provider. Also, the client may not require removal of the gallbladder. The client must see the provider promptly when experiencing gallbladder disease and should not wait. Because this client's acute pancreatitis is likely related to gallstones, alcohol consumption need not be restricted.

The nurse expects that which client will be discharged to the home environment first? A. Older obese adult who has had a laparoscopic cholecystectomy B. Middle-aged thin adult who has had a laparoscopic cholecystectomy C. Middle-aged thin adult with a heart murmur who has had a traditional cholecystectomy D. Older obese adult with chronic obstructive pulmonary disease (COPD) who has had a traditional cholecystectomy

B The combination of client age, a thin frame, and the type of procedure performed will determine that the middle-aged thin client who had a laparoscopic cholecystectomy will be discharged first. Although the older obese client who had a laparoscopic cholecystectomy will have a faster discharge time than one with a traditional cholecystectomy, the client's obesity and age probably will require a longer stay. A traditional cholecystectomy will always require a longer recovery time. The older obese client with a history of COPD will likely have a more lengthy recovery because of associated breathing problems.

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a patient who has acute pancreatitis? A. Calcium B. Bilirubin C. Amylase D. Potassium

C Rationale: Amylase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.

What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? A. The client must not consume alcohol. B. Avoid sharing the bathroom with the client. C. Members of the household must not share toothbrushes. D. Drink only bottled water and avoid ice.

C Toothbrushes, razors, towels, and items that may spread blood and body fluids should not be shared. The client should not consume alcohol, but abstention will not prevent spread of the virus. The client may share a bathroom if he or she is continent. To prevent hepatitis A when traveling to foreign countries, bottled water should be consumed and ice made from tap water should be avoided.

The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? A. Antibiotic(s) and nonsteroidal anti-inflammatory drugs (NSAIDS) B. Antibiotic(s), aspirin, and antiulcer/protectant C. Antibiotic(s), antacid, and corticosteroids D. Antibiotic(s) and proton pump inhibitors, bismuth.

C. Antibiotic(s), proton pump inhibitor, and bismuth To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

A client with acute cholecystitis is admitted to the medical-surgical unit. Which nursing activity associated with the client's care will be best for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Assessing dietary risk factors for cholecystitis B. Checking for bowel sounds and distention C. Determining precipitating factors for abdominal pain D. Obtaining the admission weight, height, and vital signs

D Rationale Obtaining height, weight, and vital signs is included in the education for UAP and usually is included in the job description for these staff members. Assessment, checking bowel sounds, and determining precipitating factors for abdominal pain require broader education and are within the scope of practice of licensed nursing staff.

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

D. The ICU nurse is familiar with the care of a client with peritonitis, including monitoring for complications such as sepsis and kidney failure. The client with CD who has a draining enterocutaneous fistula, the client with UC who needs discharge teaching, and the client with questions about an ileo-anal reservoir are best assigned to a medical-surgical nurse who is more familiar with the care and teaching needed for clients with their respective disorders.

Assessment post left sided extracorporeal shock wave lithotripsy

Lithotripsy or extracorporeal shock wave lithotripsy (SWL) 1. Use of sound, laser or dry shock waves to break the stone into small fragments 2. Patient receives moderate sedation and lies flat on table with lithotripter aimed at the stone, which is located by fluoroscopy. After lithotripsy, strain the urine to monitor the passage of stone fragments. Bruising may occur on the flank of the affected side. Occasionally a stent is placed in the ureter before SWL to ease passage of stone fragments

The admission assessment for a patient with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 beaths/min. Which admission request does the nurse implement first? A. Type and crossmatch for 4 units of packed RBCs B. Infuse 0.9% normal saline solution at 200 mL/hr C. Give pantoprazole (Protonix) 49 mg IV now and then daily D. Insert a NG tube and connect to low intermittent suction

Rationale: B The nurse must first infuse 0.9% normal saline solution at 200 mL/hr for the patient with acute gastric bleeding and hypotension associated with volume loss. The nurse's immediate concern is correcting the hypovolemia. A type of crossmatch, administration of pantoprazole, and insertion of NG tube must all be done eventually

A patient in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? A. Teach the patient about antacid effects and side effects. B. Ask the patient about oral intake, current medications and description of episodes C. Suggest that the patient sleep with the head elevated 6 inches (15 cm) D. Tell the patient to avoid drinking alcohol late in the evening

Rationale: B/ Before suggesting interventions, nurse must elicit more information.

The nurse is caring for a client with a bleeding duodenal ulcer who was admitted to the hospital after vomiting bright, red blood. Which condition does the nurse anticipate when the client develops a sudden, sharp pain in the midepigastric region and a rigid, board-like abdomen? A. Pancreatitis B. Ulcer perforation C. Small bowel obstruction D. Development of additional ulcers

Rationale: B/ The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This results in board-like abdominal rigidity, usually with extreme pain. Perforation is a medical emergency requiring immediate surgical intervention because peritonitis develops quickly after perforation.

The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a patient's GERD. Which change does the nurse recommend to this patient? A. Eat only two or three meals daily. B. Sleep flat in a left side-lying position. C. Drink tea instead of coffee. D. Avoid working while bent over the computer

Rationale: D/ Avoid working while bent over because the position presses on the diphgram, causing discomfort

The nurse reviews a medication history for a patient newly diagnosed with PUD who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the primary HCP will request which medication for this patient? A. Bismuth subsalicylate (Pepto-Bismol) B. Magnesium hydroxide (Maalox) C. Metronidazole (Flagyl) D. Misoprostol (Cytotec)

Rationale: D/ Misoprostol is a prostaglandin analogue that protects against NSAID-induced ulcers. Bismuth subsalicylate is an antidiarrhea drug that contains salicylates, which can cause bleeding and would be avoided in patients who have PUD Magnesium hydroxide is an antacid that may be used to neutralize stomach secretion but is not specific to prevent NSAID-induced ulcers Metronidazole is an antimicrobial agent used to treat H.pylori infection.

PUD triple and quadruple therapy

Triple: PPI + 2 Abx Quadruple: PPI+2 ABX+ bismuth subsalicylate

A nurse assesses a client who is recovering from extracorporeal shock wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the clients right lower back. Which action should the nurse take? a. Administer fresh-frozen plasma. b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results.

a. Administer fresh-frozen plasma. b. Apply an ice pack to the site. c. Place the client in the prone position. d. Obtain serum coagulation test results.

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalance? A. hyperkalemia and hyponatremia B. hyperkalemia and hypernatremia C. hypokalemia and hyponatremia D. hypokalemia and hypernatremia

c

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

c Rationale: C/ IV fluids is necessary to treat hypovolemia caused by acute GI bleeding.

After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first? a. document the QRS interval b. notify the pts HCP c. look at the pts current BUN and creatinine levels d. check the chart for the most recent blood potassium level

d The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.

Lab values pertinent for acute pancreatitis

o Decreased pancreatic enzyme levels show effectiveness of treatment. These are elevated with onset of acute pancreatitis and fall as it resolves: ▪ Decreased serum amylase (most specific): amylase levels usually increase within 12 to 24 hours and remain elevated for 2 to 3 days ▪ Decreased serum lipase: Serum levels may rise later than amylase and remain elevated for up to 2 weeks o Decreased WBC count o Elevated serum glucose - pancreatic cell injury, resulting in impaired carb metabolism; decrease insulin release

Education for a patient with Crohn's disease

• The discharge plan for the patient with Crohn's disease is similar to the patient with UC • Manage nutrition • Teach the patient and family to make arrangements for the patient to have easy access to the bathroom and privacy to perform fistula care if needed • Low residue diet, high calorie diet • Avoid foods that cause discomfort such as milk, gluten (wheat products) and caffeine • Take rest periods, especially during exacerbations of the disease • Stress appears to increase symptoms of disease