Exam #5: CH. 38, 39, 41, and 42

Which item should the nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting? A- Glass or orange juice B- Dish of lemon gelatin C- Cup of coffee with cream D- Hydrogen peroxide rinses

B- Dish of lemon gelatin RATIONALE: Clear cool liquids are usually the first foods started after a patient has been nauseated.

A healthy adult women who weighs 145 lb (66kg) asks the clinic nurse about the minimum daily requirement for protein. How many grams of protein will the nurse recommend? A- 53 B- 66 C- 79 D- 98

A- 53 RATIONALE: The recommended daily protein intake is 0.8 to 1 g/kg of body weight

What diagnostic test should the nurse anticipate for an older patient who is vomiting coffee-ground emesis? A- Endoscopy B- Angiography C- Barium Studies D- Gastric Anaylsis

A- Endoscopy RATIONALE: endoscopy is the primary tool for visualization and diagnosis of upper GI bleeding.

A women receiving chemotherapy for breast cancer develops a Candida albicans oral infection. Which intervention should the nurse anticipate? A- Nystatin tablets B- Antiviral agents C- Referral to a dentist D- Hydrogen peroxide rinses

A- Nystatin tablets RATIONALE: C. albicans infections are treated with an antifungal such as nystatin

Which action should the nurse in the emergency department anticipate for a young adult patient who has had several acute episodes of bloody diarrhea? A- Obtain a stool specimen for culture B- Administer antidiarrheal medication C- Provide teaching about antibiotic therapy D- Teach the adverse effects of tylenol

A- Obtain a stool specimen for culture RATIONALE: Patients with bloody diarrhea should have a stool culture for e. coli.

A 58-year old patient has just returned to the nursing unit after a EGD. Which action by the UAP requires that the RN intervene? A- Offering the patient a pitcher of water B- Positioning the patient on the right side C- Checking the vital signs every 30 minutes D- Swabbing the patients mouth with a wet cloth

A- Offering the patient a pitcher of water RAITIONALE: Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex is to be done by the RN.

Which finding for a young adult who follows a vegan diet may indicate the need for cobalamin supplementation? A- Paresthesia's B- Ecchymosis C- Dry, scaly skin D- Gingival swelling

A- Paresthesia's RATIONALE: Cobalamin cannot be obtained from foods of plant origin, so the patient will be most at risk for signs of Vitamin b12 deficiency such as: paresthesia's, peripheral neuropathy, and anemia.

A patient is being scheduled for a ERCP asap. Which prescribed action should the nurse take first? A- Place the patient on NPO status B- Administer sedative medications C- Ensure the consent form is signed D- Teach the patient about the procedure

A- Place the patient on NPO status RATIONALE: The patient will need to be NPO for 8 hours prior to the ERCP is done, so the nurse's initial action should be to place the patient on NPO status.

A patient who has just started on enteral nutrition of full-strength formula at 100mL/hr has 6 liquid stools the first day. Which action should the nurse plan to take? A- Slow the infusion rate of the feeding B- Check gastric residual volumes more often C- Change the enteral feeding system and formula every 8 hours D- Discontinue administration of water through the feeding tube

A- Slow the infusion rate of the feeding RATIONALE: Loose stools indicate poor absorption of nutrients and indicate a need to slow the feeding rate or decrease the concentration of the feeding.

The nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient to the procedure? A- The patient declined to drink the prescribed laxative B- The patient has had an allergic reaction to shellfish and iodine C- The patient has a permeant pacemaker to prevent bradycardia D- The patient is worried about discomfort during the examination

A- The patient declined to drink the prescribed laxative RATIONALE: If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure would be rescheduled.

A patient has just arrived in the recovery area after a upper endoscopy. Which information collected by the nurse is most appropriate to communicate to the health care provider? A- The patient is very drowsy B- The patient reports a sore throat C- The oral temperature is 100.4 D- The apical pulse is 100 beats/min

C- The oral temperature is 100.4 RATIONALE: A temp elevation may indicate an acute perforation has occurred.

Which of the nurse's assigned patients should be referred to the dietician for a complete nutritional assessment? (Select all that apply). A- A 35 year old patient who reports intermittent nausea for the past 2 days B- A 48 year old patient with rheumatoid arthritis who takes prednisone daily C- A 23 year old patient who has a history of fluctuating weight gains and losses D- A 64 year old patient who is admitted for debridement of an infected surgical wound E- A 52 year old patient admitted with chest pain and possible myocardial infarction (MI)

B, C, D RATIONALE: Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that the patient may be at risk for malnutrition.

The nurse is assessing an alert and independent older adult patient for malnutrition risk. Which is the most appropriate initial question? A- "How do you get to the store to buy your food?" B- "Can you tell me the food you ate yesterday?" C- "Do you have any difficulty in preparing or eating food?" D- "Are you taking any medications that alter your taste for food?"

B- "Can you tell me the food you ate yesterday?" RATIONALE: This question is the most open-ended and will provide the best overall information about the patients daily intake and risk for poor nutrition.

An older patient reports chronic constipation. To promote bowel evacuation, when should the nurse suggest that the patient attempt defecation? A- In the mid-afternoon B- After eating breakfast C- Right after awakening in the morning D- Immediately before the first daily meal

B- After eating breakfast RATIONALE: A gastrocolic reflex is most active after the first meal.

A severely malnourished patient reports that he is Jewish. What initial action should the nurse take to meet his nutritional needs? A- Have family members bring in food B- Ask the patient about food preferences C- Teach the patient about nutritious Kosher Foods D- Order supplements that are manufactured Kosher

B- Ask the patient about food preferences RATIONALE: The nurse's first action should be further assessment whether or not the patient follows any specific religious guidelines that impact nutrition.

Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa? A- Use sunscreen even on cloudy days B- Avoid cigarettes and smokeless tobacco C- Complete antibiotic courses used to treat throat infections D- Use antivirals to treat herpes simplex virus (HSV) infections

B- Avoid cigarettes and smokeless tobacco RATIONALE: Tobacco use greatly increases the risk for oral cancer

Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)? A- You will need to remain on a bland diet B- Avoid foods that cause pain after you eat them C- High-protein foods are least likely to cause pain D- You should avoid eating any raw fruits or vegetables

B- Avoid foods that cause pain after you eat them RATIONALE: The best information is that each person should choose foods that are not associated with postprandial discomfort.

A patient admitted with a peptic ulcer has a NG tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take? A- Irrigate the NG tube B- Check vital signs C- Give the ordered antacid D- Elevate the foot of the bed

B- Check vital signs RATIONALE: The patients symptoms are suggestive of acute perforation, and the nurse should assess for hypovolemic shock

A patient who underwent a gastroduodenostomy (Biliroth 1) 12 hours ago reports increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red NG drainage in the last hour. What is the highest priority action of the nurse? A- Monitor drainage B- Contact the surgeon C- Irrigate the NG tube D- Give prescribed morphine

B- Contact the surgeon RATIONALE: Increased pain and 200 mL of bright NG drainage 12 hours after surgery indicate possible hemorrhage, and immediate actions such as blood transfusion or return to surgery are needed (or both).

The nurse is preparing to teach a frail 79 year old Hispanic man who lives with an adult daughter about ways to improve nutrition. Which action should the nurse take first? A- Ask the daughter about the patients food preferences B- Determine who shops for groceries and prepares the meals C- Question the patient about how many meals per day are eaten. D- Assure the patient that culturally preferred foods will be included

B- Determine who shops for groceries and prepares the meals RATIONALE: The family member who shops for groceries and cooks will be in control of the patient's diet so the nurse will need to ensure that this family is involved in any teaching or discussion about the patient's nutritional needs.

Which nursing action should be included in the post op plan of care for a patient after a laparoscopic esophagectomy? A- Reposition the NG tube if drainage stops B- Elevate the head of the bed at least 30 degrees C- Start oral fluids when the patient has active bowel sounds D- Notify the doctor for any bloody nasogastric (NG) drainage

B- Elevate the head of the bed at least 30 degrees RATIONALE: Elevation of the head of bed decreases the risk for reflux and aspiration of gastric secretions

A young adult with extensive facial injuries from a motor vehicle crash is receiving continuous enteral nutrition through a percutaneous endoscopic gastrostomy (PEG). Which action should the nurse take? A- Keep the patient positioned lying on the left side B- Flush the tube with 30mL of water every 4 hours C- Crush and mix medications in with the feeding formula D- Obtain a daily abdominal radiograph to verify tube placement

B- Flush the tube with 30mL of water every 4 hours RATIONALE: All PN solutions and tubing are changed at 24 hours.

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? A- I quit smoking years ago, but I chew gum B- I eat small meals and have a bedtime snack C- I take antacids between meals and at bedtime each night D- I sleep with the head of the bed elevated on 4-inch blocks

B- I eat small meals and have a bedtime snack RATIONALE: GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime

The nurse is caring for a patient with an obstructed common bile duct. What condition does the nurse expect? A- Melena B- Steatorrhea C- Decreased serum cholesterol level D- Increased serum indirect bilirubin level

B- Steatorrhea RATIONALE: A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools.

A patient's peripheral PN bag is nearly empty, and a new PN bag has not arrived yet from the pharmacy. Which intervention by the nurse is appropriate? A- Monitor the patients capillary blood glucose every 6 hours B- Infuse 5% dextrose in water until a new PN bag is delivered C- Decrease the PN infusion rate to 10mL/hr until a new bag arrives D- Flush the peripheral line with saline until a new PN bag is available

B- Infuse 5% dextrose in water until a new PN bag is delivered RATIONALE: To prevent hypoglycemia, the nurse should infuse a 5% dextrose solution until the next peripheral PN bag can be started.

A young adult patient is hospitalized with massive abdominal trauma from a MVC. The patient asks the nurse about the purpose of receiving Pepcid. What should the nurse explain about the action of Pepcid? A- It decreases N/V B- It inhibits development of stress ulcers C- It lowers the risk of H. Pylori infection D- It prevents aspiration of gastric contents

B- It inhibits the development of stress ulcers RATIONALE: famotidine is administered to prevent the development of physiologic stress ulcers, which as associated with a major physiologic insult such as massive trauma.

What action should the nurse take when caring for a patient with a soft, silicone NG tube for enteral nutrition? A- Avoid giving medications through the feeding tube B- Keep head of bed elevated to 30-45 degree angle C- Replace the tube every 3 days to avoid mucosal damage D- Administer medications mixed with enteral feeding formula

B- Keep head of bed elevated to 30-45 degree angle RATIONALE: Elevate the head of bed to decrease the risk of aspiration.

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

B- Keep the head of your bed elevated on blocks RATIONALE: Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping

Which area of the abdomen will the nurse palpate to assess for splenomegaly? A- RUQ B- LUQ C- RLQ D- LLQ

B- LUQ RATIONALE: The spleen is usually not palpable, but when it is palpated, it is located in the left upper quadrant of the abdomen.

An adult with a BMI of 22 is being admitted to the hospital for elective knee surgery. Which assessment finding should the nurse report to the health care provider? A- Tympany on percussion of the abdomen B- Liver edge 3 cm below the costal margin C- Bowel sounds of 20/min in each quadrant D- Aortic pulsations visible in the epigastric area

B- Liver edge 3 cm below the costal margin RATIONALE: Normally the lower border of the liver is not palpable below the ribs, so this finding suggest hepatomegaly.

Which is the correct technique for the nurse to palpate the liver during a head-to-toe assessment? A- Place one hand on top of the other and use the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. B- Place one hand on the patient's back and press upward and inward with the other hand below the patient's right costal margin. C- Press slowly and firmly over the right costal margin with one hand and withdraw the fingers quickly after the liver edge is felt. D- Place one hand under the patient's lower ribs and press the left lower rib cage forward, palpating below the costal margin with the other hand.

B- Place one hand on the patient's back and press upward and inward with the other hand below the patient's right costal margin. RATIONALE: The liver is normally not palpable below the costal margin. The nurse needs to push inward below the right costal margin while lifting the patient's back slightly with the left hand.

What action should he nurse take after assisting with a needle biopsy of the liver at the patient's bedside? A- Elevate the head of the bed to facilitate breathing B- Place the patient on the right side with the bed flat C- Check the patient's post-biopsy coagulation studies D- Position a sandbag over the liver to provide pressure

B- Place the patient on the right side with the bed flat RATIONALE: After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site.

A patient has a BMI of 31, a normal CRP level, and a low serum transferrin and albumin level. What should the nurse encourage the patient to increase in their diet? A- Iron B- Protein C- Calories D- Carbohydrates

B- Protein RATIONALE: The patients CRP and transferrin levels indicate low protein stores.

Which action for a patient receiving enteral nutrition through a percutaneous endoscopic gastrostomy (PEG) may be delegated to a licensed practical/vocational nurse (LPN/LVN)? A- Assessing the patient's nutritional status weekly B- Providing skin care to the area around the tube site C- Teaching the patient how to administer the feedings D- Determining the need for adding water to the feedings

B- Providing skin care to the area around the tube site RATIONALE: LPN/LVN education and scope of practice include such as dressing changes and wound care.

Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine? A- Ranitidine absorbs the excess gastric acid B- Ranitidine decreases gastric acid secretion C- Ranitidine constricts the blood vessels near the ulcer D- Ranitidine covers the ulcer with a protective material

B- Ranitidine decreases gastric acid secretion RATIONALE: Ranitidine is a H2 receptor blocker that decreases the secretion of gastric acid.

A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports "feeling too tired to eat". Which action should the nurse take first? A- Teach the patient about the importance importance of good nutrition B- Serve multiple small feedings of high-calorie, high-protein foods C- Consult with the health care provider about parental nutrition (PN). D- Obtain an order for enteral feedings or liquid nutritional supplements

B- Serve multiple small feedings of high-calorie, high-protein foods RATIONALE: Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patient's ability to take in more nutrients.

A patient is receiving continuous enteral nutritional through a small-bore silicone feeding tube. What should the nurse plan for when this patient has computed tomography (CT) scan ordered? A- Ask the health care provider to reschedule the scan B- Shut off the feeding 30-60 minutes before the scan C- Connect the feeding tube to continuous suction before and during the scan D- Send a suction catheter with the patient in the case of aspiration during the scan

B- Shut off the feeding 30-60 minutes before the scan RATIONALE: Feeding should be shut off 30-60 minutes before any procedure requiring the patient to lie flat.

After change of shift report, which patient will the nurse assess first? A- A 40 year old women whose parental nutrition bag has 30 minutes of solution left B- a 4o year old man with continuous enteral feedings who has developed pulmonary crackles C- A 30 year old man with 4+ generalized pitting edema and severe protein-calorie malnutrition D- A 30 year old women whos gastrostomy tube is plugged after crushed medications were administered

B- a 4o year old man with continuous enteral feedings who has developed pulmonary crackles RATIONALE: The patient data suggest aspiration may have occurred, and rapid assessment and intervention needed.

Which statement by a patient with chronic atrophic gastritis indicates the nurses teaching regarding cobalamin injections has been effective? A- the cobalamin injections will prevent gastric inflammation B- the cobalamin injections will prevent me from becoming anemic C- These injections will increase the hydrochloric acid in my stomach D- These injections will decrease my risk for developing my stomach cancer

B- the cobalamin injections will prevent me from becoming anemic RATIONALE: cobalamin supplementation prevents the development of percutaneous anemia

The nurse is caring for a 47 year old female patient who is comatose and is receiving continuous nutrition through a soft nasogastric tube. The nurse notes the presence of new crackles in the patient's lungs. In which order will the nurse take action? A- Check the patient's oxygenation saturation B- Notify the patient's health care provider C- Stop administrating the continuous feeding D- Measure the gastric residual volume per agency policy

C, A, D, B RATIONALE: The assessment data indicate that aspiration may have occurred. The nurse's first action should be to turn off the enteral feeding to avoid further aspiration. Then next should be to check O2 bc it may indicate the need for immediate suctioning or oxygen administration. The residual volume provides data possible causes of aspiration. Finally, the health care provider should be notified of all the assessment data the nurse has just obtained.

Which finding by the nurse during abdominal auscultation indicated a need for a focused abdominal assessment? A- Loud gurgles B- High-pitched gurgles C- Absent bowel sounds D- Frequent clicking sounds

C- Absent bowel sounds RATIONALE: Absent bowel sounds are abnormal and require further assessment by the nurse.

An adult patient with E. coli food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question? A- Infused LR at 250 mL/hr B- Monitor BUN and Creatinine daily C- Administer Imodium after each stool D- Provide a clear liquid diet and progress as tolerated

C- Administer Imodium after each stool RATIONALE: Use of antidiarrheal agents is avoided with this type of food poisoning.

A 53 year old male patient with deep partial-thickness burns from a chemical spill in the workplace has severe pain followed by nausea during dressing changes. What action will be most useful in decreasing the patients nausea? A- Keep the patient NPO for 2 hours before dressing changes B- Give the prescribed prochlorperazine before dressing changes C- Administer prescribed morphine sulfate before dressing changes D- Avoid performing dressing changes close to the patients meal times

C- Administer prescribed morphine sulfate before dressing changes RATIONALE: Because the patients nausea is associated with severe pain, it is likely that it is precipitated by stress and pain. The best treatment will be to provide adequate medication before dressing changes

A 68 year old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of GERD, what should the nurse plan to assess more frequently than routine? A- Apical pulse B- Bowel sounds C- Breath sounds D- Abdominal girth

C- Breath sounds RATIONALE: GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia.

Which patient choice for a snack 3 hours before bedtime indicated that nurses teaching about gastroesophageal reflux disease has been effective? A- Chocolate pudding B- Glass of low-fat milk C- Cherry gelatin with fruit D- Peanut butter and jelly sandwich

C- Cherry gelatin with fruit RATIONALE: Gelatin and fruit are low fat and will not decrease lower esophageal sphincter pressure

a 58 year old women 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? A- You may have quite a few years still left to live B- Thinking about dying will only make you feel worse C- Having this new diagnosis must be very hard for you D- It is important that you be realistic about your prognosis

C- Having this new diagnosis must be very hard for you RATIONALE: This response is open ended and will encourage the patient to further discus feelings of anxiety or sadness about the diagnosis.

At his first post op check up appt after a Biliroth 2, a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. What should the nurse teach the patient to do? A- Increase the amount of fluid with meals B- Eat foods that are higher in carbohydrates C- Lie down for about 30 minutes after eating D- Drink sugared fluids or eat candy after meals

C- Lie down for about 30 minutes after eating RATIONALE: The patient is experiencing symptoms of dumping syndrome , which may be reduced by lying down after eating.

The nurse is planning care for a patient who is chronically malnourished. Which action is appropriate for the nurse to delegate to a UAP. A- Assist the patient to choose high-nutrition items from the menu B- Monitor the patient for skin breakdown over the bony prominences C- Offer the patient the prescribed nutritional supplement between meals D- Assess the patient's strength while ambulating the patient in the room

C- Offer the patient the prescribed nutritional supplement between meals RATIONALE: Feeding the patient and assisting with oral intake are included in UAP education and scope of practice.

a 76-year old women with a BMI of 17 and a low serum albumin level is being admitted. Which assessment finding will the nurse expect? A- Restlessness B- Hypertension C- Pitting edema D- Food allergies

C- Pitting edema RATIONALE: Edema occurs when the serum albumin levels and plasma oncotic pressure decrease.

A patient's capillary blood glucose is 120 mg/dL 6 hours after the nurse initiated a parental nutrition infusion. What is the appropriate action by the nurse? A- Obtain a venous blood glucose specimen B- Slow the infusion rate of the PN infusion C- Recheck the capillary blood glucose level in 4 to 6 hours D- Contact the health care provider for infusion rate changes.

C- Recheck the capillary blood glucose level in 4 to 6 hours RATIONALE: Because poor healing is a possible complication of malnutrition for this patient, normal healing of the incision is an indicator of the effectiveness of the PN providing adequate nutrition. Blood glucose is monitored to prevent complications of hyper/hypoglycemia, but it does not indicate the patients nutrition is adequate.

Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer? A- Bleeding during tooth brushing B- Painful blisters at the lip border C- Red patches on the buccal mucosa D- Curd-like plaques on the posterior tongue

C- Red patches on the buccal mucosa RATIONALE: A res, velvety patch suggests erythroplasia, which has a high incidence (>50%) of progression to squamous cell carcinoma.

While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). What area of patient knowledge should the nurse plan to assess? A- Preventing noninfectious hepatitis B- Treating inflammatory bowel disease C- Risk for developing colorectal cancer D- Using antacids and proton pump inhibitors (PPI)

C- Risk for developing colorectal cancer RATIONALE: FAP is a genetic condition that greatly increases the risk for colorectal cancer.

A 20 year-old women is being admitted with electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider? A- The patient uses laxatives daily B- The patient's knuckles are macerated C- The patient's serum potassium level is 2.9 mEq/L D- The patient has a history of extreme weight fluctuations

C- The patient's serum potassium level is 2.9 mEq/L RATIONALE: The low serum potassium level may cause life-threatening cardiac dysrhythmias, and potassium supplementation is needed rapidly.

Which information about an 80 year old patient at the senior center is of MOST concern to the nurse? A- Decreased appetite B- Occasional indigestion C- Unintended weight loss D- Difficulty chewing food

C- Unintentional weight loss RATIONALE: unintentional weight loss is not a normal finding and may indicate a problem such as caner or depression.

A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What should the nurse ask the patient about to determine possible risk factors for gastritis? A- The amount of saturated fat in the diet B- A family history of gastric or colon cancer C- Use of nonsteroidal anti-inflammatory drugs D- A history of a large recent weight gain or loss

C- Use of nonsteroidal anti-inflammatory drugs RATIONALE: Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis.

Which patient statement indicated that the nurse's postoperative teaching after a gastroduodenostomy has been effective? A- I will drink more liquids with my meals B- I should choose high carbohydrates foods C- Vitamin supplements may prevent anemia D- Persistent heartburn is common after surgery

C- Vitamin supplements may prevent anemia RATIONALE: Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injection or nasal spray.

A patient has PUD that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient? A- Sucralfate (Carafate), nysatin, and bismuth (pepto-Bismol) B- Metoclopromide (reglan), bethanechol (Urecholine), and promethazine C- amoxicillin, clarithromycin, omeprazole D- Famotidine, magnesium hydroxide, and pantoprazole.

C- amoxicillin, clarithromycin, omeprazole RATIONALE: the drugs used in triple drug therapy include a PPI, and antibiotics

Which statement to the nurse from a patient with jaundice indicate a need for teaching? A- "I used cough syrup several times a day last week." B- "I take a baby aspirin every day to prevent strokes." C- "I take an antacid for indigestion several times a day." D- "I used acetaminophen (Tylenol) every 4 hours for pain."

D- "I used acetaminophen (Tylenol) every 4 hours for pain." RATIONALE: Chronic use of high doses of acetaminophen can be hepatotoxic and may have cause the patient's jaundice.

The health care provider prescribes antacids and sucralfate for treatment of a patients peptic ulcer. What should be the nurse teach the patient to take? A- Sucralfate at bedtime and antacids before each meal B- Sucralfate and antacids together 30 minutes before each meal C- Antacids 30 minutes before each dose of sucralfate is taken D- Antacids after meals and sucralfate 30 minutes before meals

D- Antacids after meals and sucralfate 30 minutes before meals RATIONALE: Sucralfate is most effective when the pH is low and should not be given with or soon after antacids

A 60 year old man who is hospitalized with an abdominal wound infection has been eating very little and states "Nothing on the menu sounds good". Which action by the nurse will be most effective in improving the patient's oral intake. A- Order six small meals daily B- Make a referral to the dietitian C- Teach the patient about high-calorie foods D- Ask family members to bring favorite foods.

D- Ask family members to bring favorite foods. RATIONALE: The patient's statement that the hospital foods are unappealing indicates that favorite home-cooked foods might improve intake.

What condition should the nurse anticipate when caring for a patient with a history of a total gastrectomy? A- Constipation B- Dehydration C- Elevated total serum cholesterol D- Cobalamin (vitamin b12) deficiency

D- Cobalamin (Vitamin b12) deficiency RATIONALE: The patient with a total gastrectomy does not secrete intrinsic factor, which is needed to absorb b12.

Which menu choice best indicates that the patient is implementing the nurse's suggestion to choose high-calorie, high-protein foods? A- Baked fish with applesauce B- Beef noodle soup and canned corn C- Fresh fruit salad with yogurt topping D- Fried chicken with potatoes and gravy

D- Fried chicken with potatoes and gravy RATIONALE: Foods that are high in calories include fried foods and those covered with sauces. High protein foods include meat and dairy products.

How should the nurse explain esomeprazole (Nexium) to a patient with recurring heartburn? A- It reduces gastroesophageal reflux by increasing the rate of gastric emptying B- It neutralizes stomach acid and provides relief of symptoms in a few minutes C- It coats and protects the lining of the stomach and esophagus and gastric acid D- It treats GERD by decreasing stomach acid production

D- It treats GERD by decreasing stomach acid production RATIONALE: The proton pump inhibitors decrease the rate of gastric acid secretion.

A patient who takes NSAIDs daily for the management of severe RA has recently developed melena. What should the nurse anticipate teaching the patient? A- Substitution of Tylenol for the NSAID B- Use of enteric-coated NSAID to reduce gastric irritation C- Reasons for using corticosteroids to treat the RA D- Misoprostol to protect the GI mucosa

D- Misoprostol to protect the GI mucosa RATIONALE: Misoprostol is a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use

a 73 year-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? A- Refer the patient to hospice for services B- Infuse IV fluids through a central line C- Teach the patient about antiemetic therapy D- Offer supplemental feedings between meals

D- Offer supplemental feedings between meals RATIONALE: The patient data indicate a poor nutritional state and improvement of nutrition will be helpful in improving the response to therapies such as surgery, chemo, and radiation.

What should the nurse anticipate teaching a patient with a new report of heartburn? A- A barium swallow B- Radionuclide tests C- Endoscopy Procedures D- Proton Pump Inhibitor

D- Proton pump inhibitor RATIONALE: Because diagnostic testing for heartburn that is probably caused by GERD is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD.

A 19-year old women admitted with anorexia nervosa is 5ft 6in tall and weighs 88lb (41kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which patient problem has the highest priority? A- Difficulty coping B- Disturbed body image C- Impaired nutritional status D- Risk for electrolyte imbalance

D- Risk for electrolyte imbalance RATIONALE: The patients hypokalemia may lead to a life-threatening cardia dysrhythmia

A patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicated that the ultrasound may need to be rescheduled? A-The patient took a laxative the previous evening B- The patient had a high-fat meal the previous evening C- the patient has a permanent gastrectomy tube in place D- The patient at a low-fat bagel 4 hours ago for breakfast

D- The patient at a low-fat bagel 4 hours ago for breakfast RATIONALE: Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8-12 hours before the test.

Which information will the nurse provide for a patient with achalasia? A- A liquid diet will be necessary B- Avoid drinking fluids with meals C- Lying down after meals is recommended D- Treatment may include endoscopic procedures

D- Treatment may include endoscopic procedures RATIONALE: Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia