Exam 6 question review

Correct Answers: A. Regurgitation B. Nausea C. Belching D. Heartburn Regurgitation and heartburn are primary manifestations of GERD. Nausea and belching are also common manifestations. Incorrect Answer: E. Clients who have GERD rarely experience unplanned weight loss.

A nurse in a provider's office is assessing a client who has GERD. The nurse should expect the client to report which of the following manifestations? (Select all that apply.) A. Regurgitation B. Nausea C. Belching D. Heartburn E. Weight loss

Correct Answer: B. Bending over Gastroesophageal reflux symptoms are most evident with activities that increase intraabdominal pressure (e.g. bending over, straining, lifting, and lying down). Incorrect Answers: A. Stair-climbing does not increase intra-abdominal pressure. C. Sitting does not increase intra-abdominal pressure. D. Walking does not increase intra-abdominal pressure.

A nurse in a provider's office is assessing a client who has GERD. When documenting the client's history, the nurse should expect the client to report that symptoms worsen with which of the following actions? A. Stair-climbing B. Bending over C. Sitting D. Walking

Correct Answer: A. Emesis with a coffee-ground appearance The nurse should expect a client who has a bleeding duodenal ulcer to have emesis that resembles coffee-grounds or is bright red in color. Hematemesis indicates upper gastrointestinal bleeding, occurring at or above the duodenojejunal junction. Incorrect Answers: B. A client who has a bleeding duodenal ulcer will have a decreased blood pressure due to bleeding and fluid loss. C. A client who has a bleeding duodenal ulcer will have a decreased heart rate due to bleeding and fluid loss. D. A client who has a bleeding duodenal ulcer will have melena stools, which are tarry or dark in color and sticky.

A nurse is assessing a client who has a bleeding duodenal ulcer. Which of the following findings should the nurse expect? A. Emesis with a coffee-ground appearance B. Increased blood pressure C. Decreased heart rate D. Bright green stools

Correct Answer: A. Blumberg's sign The nurse should expect to find rebound tenderness (Blumberg's sign) in a client who has cholecystitis. This response can be an indication of peritoneal inflammation. Incorrect Answers: B. The nurse should expect to find ascites in a client who has chronic pancreatitis or pancreatic cancer. C. The nurse should expect to find gastrointestinal bleeding in a client who has pancreatic cancer. D. The nurse should expect to find a positive Kehr's sign in a client who has liver trauma.

A nurse is assessing a client who has cholecystitis. Which of the following findings should the nurse expect? A. Blumberg's sign B. Ascites C. Gastrointestinal bleeding D. Kehr's sign

Correct Answer: B. Indwelling urinary catheter output of 25 mL/hr The nurse should report a urinary output of <30 mL/hr to the provider, as this can indicate hypovolemia or renal complication. Incorrect Answers: A. Hypoactive bowel sounds are an expected finding during the initial postoperative period due to decreased peristalsis from anesthesia and analgesic medications. C. A heart rate of 96/min is within the expected range of 60 to 100/min. This is an expected finding for a client who is postoperative. An elevated heart rate can indicate hemorrhage, shock, or pain. D. A small to moderate amount of serous drainage at the surgical incision site is an expected finding during the immediate postoperative period. An increased amount of drainage can indicate the possibility of wound dehiscence.

A nurse is assessing a client who is 12 hr postoperative following an open cholecystectomy. Which of the following findings should the nurse report to the provider? A. Hypoactive bowel sounds B. Indwelling urinary catheter output of 25 mL/hr C. Heart rate of 96/min D. Serous drainage at the surgical incision site

Correct Answer: C. Rigid abdomen Abdominal tenderness and rigidity indicate a bowel perforation. As fluid escapes into the peritoneal cavity, a reduction in circulating blood volume occurs, lowering blood pressure. Incorrect Answers: A. A client who has experienced a bowel perforation will not display an elevated blood pressure. However, hypotension or shock can be present. B. Intestinal peristalsis increases in frequency and intensity as the bowel attempts to move intestinal contents past the obstructed area. Bowel sounds are silent with a bowel perforation. D. Vomiting is frequent and copious with a small bowel obstruction. This does not indicate a bowel perforation.

A nurse is assessing a client who was admitted with a bowel obstruction. The client reports severe abdominal pain. Which of the following findings indicates that a possible bowel perforation has occurred? A. Elevated blood pressure B. Bowel sounds increased in frequency and pitch C. Rigid abdomen D. Emesis of undigested food

Correct Answer: A. Prevents excessive pressure on suture lines The NG tube remains in place after surgery to prevent excessive pressure on suture lines postoperatively. It drains the air and fluid that can cause pressure from inside the gastrointestinal (GI) tract. In doing so, it also prevents vomiting and GI distention. Incorrect Answers: B. Gastric lavage is a therapy for upper gastrointestinal bleeding, but it is not necessary after a gastric resection. C. Unless specific problems prevent oral nutrition, the client will begin taking clear liquids by mouth and progress accordingly. D. Before administering an enteral feeding via an NG tube, the nurse should aspirate gastric contents to test pH; however, the client will not receive enteral feedings following gastric resection.

A nurse is caring for a client who had a gastric resection to treat adenocarcinoma of the stomach. The client tells the nurse in the PACU that he does not remember why the surgeon said he had to have a tube in his nose. The nurse should explain that the NG tube serves which of the following purposes? A. Prevents excessive pressure on suture lines B. Allows gastric lavage after surgery C. Allows early postoperative feeding D. Facilitates obtaining gastric specimens for testing

Correct Answer: A. White bread and plain yogurt Because of the acute inflammation of diverticulitis, the client should maintain a diet very low in fiber. The client can consume low-fiber foods like white bread, low-fat milk, yogurt with active cultures, poached eggs, and canned soft fruit. Incorrect Answers: B. Foods like shredded wheat cereal and blueberries can worsen the inflammation of acute diverticulitis. C. Foods like broccoli and kidney beans can worsen the inflammation of acute diverticulitis. D. Foods like oatmeal and fresh pears can worsen the inflammation of acute diverticulitis.

A nurse is caring for a client who has acute diverticulitis. While the client has active inflammation, the nurse should instruct the client to include which of the following foods in her diet? A. White bread and plain yogurt B. Shredded wheat cereal and blueberries C. Broccoli and kidney beans D. Oatmeal and fresh pears

Correct Answer: A. Ensure bowel rest Clients who have an exacerbation of Crohn's disease usually require NPO status to ensure bowel rest and promote healing and recovery. Incorrect Answers: B. Carbonated beverages can worsen an exacerbation of Crohn's disease. C. A client with an exacerbation of Crohn's disease is already having many stools per day. A stool softener might worsen the situation. D. Caffeinated beverages and alcohol can worsen an exacerbation of Crohn's disease.

A nurse is caring for a client who has an acute exacerbation of Crohn's disease. Which of the following actions should the nurse take? A. Ensure bowel rest B. Offer sparkling water frequently C. Administer a stool softener D. Offer plain warm tea frequently

Correct Answer: C. Storing bile The primary function of the gallbladder is to store bile. Because this organ is only for storage, the client's liver will still produce the bile needed for digestion. Small amounts of bile will continuously enter the duodenum, where it will perform various functions. Incorrect Answers: A. The liver produces bile. B. The stomach, pancreas, and small intestines produce the various fluids and enzymes that help accomplish the process of digestion. D. The gastrointestinal tract eliminates bile as well as other byproducts and waste via feces.

A nurse is caring for a client who has cholelithiasis and will undergo a cholecystectomy. The client states she does not understand how she will be alright without her gallbladder. The nurse should explain to the client that which of the following is the main function of the gallbladder? A. Producing bile B. Adding digestive enzymes to bile C. Storing bile D. Eliminating bile

Correct Answer: D. "Perhaps we should review your coping mechanisms and talk about other alternatives." Reviewing coping mechanisms and alternative coping patterns will promote coping skills that can assist the client in reducing stress. Incorrect Answers: A. This response does not address the client's concerns and can cause additional stress for the client. B. The client might not want to work part-time. Also, part-time work might not relieve the client's stress. C. This response does not address the client's concerns and can cause additional stress.

A nurse is caring for a client who has colitis and reported increased exacerbations due to stress at work. Which of the following responses should the nurse make? A. "I will contact the social worker so you can discuss career alternatives." B. "Have you thought about discussing the possibility of a part-time assignment with your employer?" C. "Why don't you ask your employer to relieve you of some work until you are stronger?" D. "Perhaps we should review your coping mechanisms and talk about other alternatives."

Correct Answer: B. "Lying quietly in bed helps slow down the activity in your intestines." The greatest risk to the client is complications from severe diarrhea such as dehydration, electrolyte imbalances, and gastrointestinal bleeding and trauma. Activity restriction can help reduce intestinal peristalsis and diarrhea. Incorrect Answers: A. While bed rest does conserve energy, this is not the priority reason for this prescription. C. While bed rest does promote rest and comfort, this is not the priority reason for this prescription. D. While bed rest does help prevent injury, this is not the priority reason for this prescription.

A nurse is caring for a client who has ulcerative colitis. The provider prescribes bed rest with bathroom privileges. When the client asks the nurse why he has to say in bed, which of the following responses should the nurse provide? A. "You need to conserve energy at this time." B. "Lying quietly in bed helps slow down the activity in your intestines." C. "Staying in bed promotes the rest and comfort you need." D. "Staying in bed will help prevent injury and minimize your fall risk."

Correct Answer: C. 200 mL of bright red drainage from the NG tube The nurse should notify the provider immediately if 200 mL of bright red drainage comes from the NG tube 2 days following gastric surgery. Drainage should be either a yellow-green color or clear. Bright red drainage indicates blood loss and can be the result of a disrupted suture line or other internal bleeding. Volume loss from blood is a medical emergency, and the provider should be immediately notified. Incorrect Answers: A. The nurse should expect a client who has an NG tube following gastric surgery to have a dry mouth and nose, accompanied by thirst. The nurse can offer a lubricant for the nose and lips and provide ice chips, if they are approved by the provider. B. The nurse should expect bowel sounds to be hypoactive following gastric surgery. Resumption of bowel sounds occurs slowly and indicates a return of peristalsis, which promotes healing. When peristalsis returns, the NG tube can be removed. D. The nurse should expect the NG suction to be set at low continuous suction unless otherwise noted by the provider. The nurse can check the suction canister for drainage and the client's stomach for bloating and distention to determine if the decompression is effective.

A nurse is caring for a client who is 2 days postoperative following gastric surgery and has an NG tube inserted. Which of the following findings should the nurse report to the provider? A. Dryness of the mucous membranes B. Hypoactive bowel sounds in all quadrants C. 200 mL of bright red drainage from the NG tube D. Suction set at continuous low suction

Correct Answer: C. Hydrocortisone The nurse should identify that a client who has Addison's disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels. Incorrect Answers: A. Rifampin is an antiviral medication used to treat tuberculosis. B. Loperamide is an antidiarrheal, but this client is experiencing nausea and vomiting. D. Spironolactone is a potassium-sparing diuretic. A client who has Addison's disease has increased potassium levels, along with low sodium levels as a result of fluid depletion. The nurse should anticipate administering fluids and electrolytes to the client to restore the volume lost.

A nurse is caring for a client with Addison's disease who has been admitted with muscle weakness, dehydration, and nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? A. Rifampin B. Loperamide C. Hydrocortisone D. Spironolactone

Correct Answer: D. Alcohol use Alcohol consumption is a major cause of chronic pancreatitis in the US. Long-term alcohol use disorder produces hypersecretion of protein in pancreatic secretions, which results in protein plugs and calculi within the pancreatic ducts. Alcohol also has a direct toxic effect on the cells of the pancreas. Damage to these cells is more likely to occur and to be more severe in clients whose diets are poor in protein content and either very high or very low in fat. Incorrect Answers: A. A high-calorie diet can contribute to heart disease and obesity, but it does not cause chronic pancreatitis. B. A prior gastrointestinal illness does not cause or contribute to chronic pancreatitis. C. Tobacco use can contribute to heart disease and increases the risk of cancer development, but it does not cause chronic pancreatitis.

A nurse is completing a history and physical assessment for a client who has chronic pancreatitis. Which of the following findings should the nurse identify as a likely cause of the client's condition? A. High-calorie diet B. Prior gastrointestinal illnesses C. Tobacco use D. Alcohol use

Correct Answer: C. Decrease the client's fat intake The nurse should decrease the client's fat intake to reduce the occurrence of biliary colic. Incorrect Answers: A. The nurse should not restrict fluid intake for a client who has cholelithiasis to reduce the risk of dehydration. B. The nurse might restrict the intake of calcium for a client who has calcium phosphate kidney stones. D. The nurse should decrease potassium intake for a client who has chronic kidney disease to reduce the risk of hyperkalemia.

A nurse is planning care for a client who has cholelithiasis. Which of the following interventions should the nurse include in the plan? A. Restrict the client's fluid intake B. Restrict the client's calcium intake C. Decrease the client's fat intake D. Decrease the client's potassium intake

Correct Answer: D. Maintain a supine position after meals The nurse should instruct the client to lie supine after eating to help slow the rapid emptying of food into the small intestine. A client who has dumping syndrome should decrease the amount of food eaten at once, eat small meals more frequently, and eliminate fluids at mealtime. Fluid shifts occur in the upper gastrointestinal tract when food contents and simple sugars exit the stomach too rapidly, attracting fluid into the upper intestine and decreasing blood volume, which causes the client to experience nausea and vomiting, sweating, syncope, palpitations, increased heart rate, and hypotension. Incorrect Answers: A. The nurse should instruct the client to include foods containing protein at each meal and only to eat 1 or 2 foods from each food group at once. Protein, fats, and complex carbohydrates are better tolerated by a client who recently had gastric bypass surgery. B. The nurse should instruct the client to avoid drinking liquids during meals and to wait 30 to 60 minutes after eating solid foods to drink liquids. Drinking liquids with meals increases the motility of the gastrointestinal tract. C. The nurse should instruct the client to avoid eating foods that contain simple sugars. Simple sugars increase the hypertonicity of the gastrointestinal tract, which increases the movement of the food bolus.

A nurse is providing dietary teaching to a client who has dumping syndrome following gastric bypass surgery 4 days ago. Which of the following recommendations should the nurse include in the teaching? A. Avoid foods containing protein B. Drink liquids during each meal C. Eat foods that contain simple sugars D. Maintain a supine position after meals

Correct Answer: D. "Eat protein with each meal." The nurse should instruct the client to eat meals that are high in protein and fat with low to moderate carbohydrate content. Protein should be included in every meal because it delays digestion, which helps reduce the manifestations of dumping syndrome. Incorrect Answers: A. The client should avoid fluids at mealtimes to decrease gastric stimulation. B. The client should lie down when experiencing early manifestations of dumping syndrome (e.g. tachycardia, syncope, or sweating) to slow the progress of food through the gastrointestinal tract. C. The client should avoid simple carbohydrates such as honey, sugar, and syrup because they aggravate the stomach and worsen manifestations of dumping syndrome.

A nurse is providing postoperative teaching about the management of dumping syndrome to a client who had a partial gastrectomy. Which of the following instructions should the nurse include in the teaching? A. "Consume at least 4 oz of fluid with meals." B. "Take a short walk after each meal." C. "Use honey to flavor foods such as cereal." D. "Eat protein with each meal."

Correct Answer: C. Turkey and cheese sandwich A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. A client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. Addison's disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison's disease occurs when the adrenal glands do not produce enough cortisol and, in some cases, aldosterone. Incorrect Answers: A. B. D. Bananas, baked potatoes, and plain yogurt with peaches are high in potassium. A client who has Addison's disease requires a diet low in potassium because this condition causes hyperkalemia.

A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching? A. Sliced bananas B. Baked potato C. Turkey and cheese sandwich D. Plain yogurt with peaches

Correct Answer: A. Oranges and tomatoes Symptoms of GERD worsen following the oral intake of substances that decrease lower esophageal stricture (LES) pressure. These include alcohol, caffeine, nicotine, chocolate, fatty foods, citrus fruits, tomatoes, and peppermint. Incorrect Answers: B. Carrots and bananas do not worsen symptoms of GERD. C. Potatoes and squash do not worsen symptoms of GERD. D. Whole wheat and beans do not worsen symptoms of GERD.

A nurse is recommending dietary modifications for a client who has GERD. The nurse should suggest eliminating which of the following foods from the client's diet? A. Oranges and tomatoes B. Carrots and bananas C. Potatoes and squash D. Whole wheat and beans

Correct Answers: B. Diaphoresis D. Palpitations E. Shakiness Diaphoresis, palpitations, and shakiness are sympathetic nervous system responses to hypoglycemia. Incorrect Answers: A. Tachycardia is a manifestation of the body's response to stimulation of the sympathetic nervous system due to hypoglycemia. C. Deep, rapid respirations, which are referred to as Kussmaul respirations, are a manifestation of hyperglycemia.

A nurse is teaching a client who has diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include? (Select all that apply.) A. Bradycardia B. Diaphoresis C. Deep, rapid respirations D. Palpitations E. Shakiness

Correct Answer: C. Increase caloric intake with meals Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in the loss of protein stores and a negative nitrogen balance. Even with an increased appetite, meeting energy demands is often difficult, and weight loss is common. Muscle weakness and wasting can develop without adequate caloric and protein intake. Incorrect Answers: A. Clients who have hyperthyroidism often report an inability to sleep. A decreased attention span and mild to severe hyperactivity are common. The nurse should suggest frequent rest periods in a quiet environment. B. Clients who have hyperthyroidism often have a low-grade fever and diaphoresis due to their hypermetabolic state. A cool environment can decrease the discomfort of heat intolerance. D. Clients who have hyperthyroidism are often restless and have an increased systolic blood pressure, tachycardia, and other dysrhythmias. During the acute phase, increased activity is not an appropriate recommendation.

A nurse is teaching a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include? A. Reduce total hours of sleep B. Keep the immediate environment warm C. Increase caloric intake with meals D. Gradually increase activity

Correct Answer: B. "This procedure can determine how well the lower part of your esophagus works." An EGD is useful in determining the function of the esophageal lining and the extent of inflammation, potential scarring, and strictures. Incorrect Answers: A. A pH probe study, which involves the insertion of a specially designed probe into the distal esophagus, is performed to monitor for the presence of acid in the normally alkaline esophagus. C. An EGD is performed while the client receives moderate sedation. D. A colonoscopy is performed to detect colon cancer.

A nurse is teaching a client with Barrett's esophagus who is scheduled to undergo an esophagogastroduodenoscopy (EGD). Which of the following statements should the nurse include in the teaching? A. "This procedure is performed to measure the presence of acid in your esophagus." B. "This procedure can determine how well the lower part of your esophagus works." C. "This procedure is performed while you are under general anesthesia." D. "This procedure can determine if you have colon cancer."

Correct Answer: D. Eat a source of protein with each meal The nurse should include in the client's plan of care the instruction to eat a source of protein with each meal because protein delays gastric emptying. Incorrect Answers: A. The nurse should recommend consuming beverages between meals, which delays gastric emptying. B. The nurse should recommend consuming small, frequent meals each day to delay gastric emptying and assist with digestion. C. The nurse should recommend including low-fiber foods in the diet to delay gastric emptying.

A nurse is updating the plan of care for a client who has dumping syndrome. Which of the following instructions should the nurse include? A. Consume beverages with meals B. Eat 3 large meals per day C. Include high-fiber foods in the diet D. Eat a source of protein with each meal

Answer: A Rationale: Acute adrenal insufficiency, or adrenal crisis, is a life-threatening emergency that leads to severe hypovolemia and hypotension and may be seen in patients who are abruptly withdrawn from glucocorticoid therapy. Risk factors for adrenal crisis are seen in patients who have underlying adrenal hypofunction and who undergo stressful events such as trauma, surgery, and infections. Because of the decrease in aldosterone and cortisol, the patient loses excess sodium accompanied by fluid loss.

A patient has been receiving doses of prednisone for treatment of rheumatoid arthritis for the past 3 months. If this medication is suddenly discontinued, for which complication is the patient at risk? A. Hypovolemia B. Hypernatremia C. Hypothermia D. Hyperglycemia

Answer: B Rationale: Once the trauma patient's airway, breathing, and circulation have been thoroughly assessed, then the patient needs to be evaluated for signs of hemorrhage, shock, and peritonitis. Vital signs and mental status examination are priority nursing assessments. The clinical manifestations vary widely according to the organ of injury, and assessment includes the presence, location, and quality of any pain experienced by the patient.

A patient has just been brought to the emergency department by emergency medical services after a motor vehicle accident. What is the first thing the nurse should do? A. Ask the patient if he or she is in pain. B. Perform a mental status examination and check vital signs. C. Ask the patient to move all extremities. D. Order laboratory tests.

Answer: B Rationale: Patients with diverticulitis who are hospitalized are treated with broad-spectrum antibiotics, IV fluids, and placed NPO to allow the bowel to rest. The patient may have a nasogastric (NG) tube for bowel decompression. Laxatives and enemas should be avoided because they increase intestinal motility. Pain medications may be given as needed, and opiates are frequently needed. If patients develop complications such as perforation, hemorrhage, obstruction, or abscess, they may require surgery to remove the diseased portion of the colon.

A patient is admitted to the hospital for treatment for diverticulitis. The nurse recognizes which interventions appropriate for this patient? A. High-fiber diet, ambulate frequently, IV fluids, pain medications B. Antibiotics, IV fluids, NPO, NG tube, pain medications C. Laxatives, enemas, diet, pain medications D. Surgery with follow-up physical therapy

Answer: C Rationale: Cortisol leads to increased reabsorption of sodium and excretion of potassium. Cortisol also leads to increased serum glucose. Calcium is primarily controlled by parathormone (PTH) from the parathyroid gland.

A patient is undergoing a stimulation test to assess adrenal function. After the administration of cortisol, which laboratory result indicates normal function? A. Decreased blood glucose B. Decreased serum sodium C. Decreased serum potassium D. Decreased serum calcium

Answer: C Rationale: The first sign that may appear in the elderly is a change in mental status. Baseline temperature is often decreased from normal in the older adult. Therefore, one of the most common signs of infection may not be apparent in the older adult and the patient may present with increased confusion, falling, and anorexia.

An 80-year-old patient is admitted to the hospital for diverticulitis. The family states that the family member isn't acting normally. The patient does not have specific complaints. The nurse correlates this data to which characteristics of older adults? A. They typically complain of a lot of pain with diverticulitis. B. They often have referred pain to another site. C. They may exhibit a change in mental status before any other symptoms occur. D. They will be having other symptoms such as nausea and vomiting

Answer: A Rationale: The stool of patients with ulcerative colitis is usually watery diarrhea, with blood in the stool. Constipation is associated with disorders that slow GI motility, such as opioids. Belching is usually associated with disorders of the upper gastrointestinal system, and chest pain is associated with GERD and hiatal hernias.

Case Study: Episode 1 Follow this patient throughout the chapter. Jack Conner is a 17-year-old male who has been experiencing abdominal pain and has recently noticed blood in his stool. He has been awakening at night frequently to have bowel movements, all grossly bloody and watery. He has only recently let his parents know of these problems, and an appointment is made with his primary healthcare provider. Jack is a high school senior who is involved in theatre and choir activities in school ... Case Study: Episode 2 Mr. Conner presents to his primary care provider with complaints of abdominal pain and bloody stools (12 to 14 stools per day). He describes that he has been having bright red blood in his stools for 6 months with abdominal pain that began shortly thereafter. On examination, abdominal pain is diffuse in location and sharp in character. A stool sample reveals watery consistency with blood streaks and "pus" or "droplets of fat" floating on top of the stool along with spasms of the anal sphincter and persistent desire to empty the bowel. On the basis of his clinical presentation, a colonoscopy is scheduled ... Case Study: Wrap-up A colonoscopy shows that Jack has multiple ulcerative lesions in the descending colon. His upper gastrointestinal endoscopy is negative. The wireless capsule endoscopy is negative. His vital signs are: temperature is 100.5°F (38°C); pulse is 133; respiratory rate is 24; blood pressure is 122/75 mm Hg; pain score is 7/10 (0 to 10 pain scale). His weight is 62 kg (136.4 lb), and his height is 165.5 cm (65.2 in.). His hemoglobin is 7.6 g/dL, and his hematocrit is 21.2%. Jack's diagnosis is ulcerative colitis. Jack Conner undergoes surgery for his ulcerative colitis. He had the first of two surgeries: colectomy, mucosal proctectomy, and ileal pouch-anal canal anastomosis. Jack has a temporary ileostomy. He will return to the hospital in 2 to 3 months to have the ileostomy reversed. Case Study Questions 1. What clinical manifestations does Jack display that are consistent with a diagnosis of ulcerative colitis? (Select all that apply.) A. Bloody stools B. Constipation C. Belching D. Chest pain E. Dysphagia

Answer: C Rationale: Cortisol is the primary glucocorticoid released from the adrenal cortex. Primary endocrine disorders are associated with the endocrine gland, and in this example, the adrenal cortex. Secondary endocrine disorders are related to anterior pituitary gland dysfunction, and tertiary disorders are related to hypothalamic dysfunction. The adrenal medulla secretes epinephrine and norepinephrine.

Case Study: Episode 1 Follow this patient throughout the chapter. Melinda Davis, a 32-year-old female, makes an appointment with her adult nurse practitioner because of changes in her menstrual cycle and concerns about difficulty getting pregnant. Ms. Davis is employed in a daycare center, and she and her spouse have been trying to conceive for about 10 months ... Case Study: Episode 2 Ms. Davis is seen by her nurse practitioner about her complaints of inability to conceive and changes in menstrual cycles. During the history, she reports increased swelling of her hands and feet and is unable to wear her wedding ring. Additionally, she has gained about 8 pounds in the last month. She complains of increasing fatigue and has noticed that she seems to bruise "just by bumping into things." Her blood pressure is higher than previous measurements. On the basis of these findings, the nurse practitioner orders a complete metabolic panel, abdominal x-rays, cortisol levels, and a dexamethasone suppression test ... Case Study: Wrap-up Ms. Davis returns to the nurse practitioner the following week to review the results of her diagnostic evaluation. Her serum glucose level is 154 mg/dL, and her potassium level is 3.0 mEq/L. Her blood pressure remains elevated, and she has gained another pound in the last week. The abdominal x-rays are suggestive of a mass on the right adrenal gland, and a follow-up CT scan of the abdomen demonstrates a mass on the right adrenal gland. On the basis of this finding and the abnormal results of the dexamethasone suppression test, Ms. Davis is diagnosed with primary hypercortisolism secondary to a hypersecreting tumor and undergoes a right adrenalectomy. Case Study Questions 1. The nurse correlates primary hypercortisolism to dysfunction of which gland? A. Hypothalamus B. Anterior pituitary gland C. Adrenal cortex D. Adrenal medulla

Answer: • C. The client reports having the "flu" and temp is 100.4

NCLEX Question • The client is on prednisone following an exacerbation of ulcerative colitis, which assessment finding is of greatest concern? • A. The client indicated delayed wound healing on a scratch • B. The client's glucose this morning is 142 • C. The client reports having the "flu" and temp is 100.4 • D. The client indicates that he has gained weight

Answer: C. The 65-year old with IBS who has tented turgor and dry mucous membranes. A. The 44-yr old with peptic ulcer disease who is complaining of acute epigastric pain B. The 74 year old client with gastroenteritis who has had 4 loose stools during the night. D. The 20 year old with food poisoning who has vomited several times during the night.

NCLEX Question • The nurse has received am shift report. Which client should the nurse assess first? • A. The 44-yr old with peptic ulcer disease who is complaining of acute epigastric pain • B. The 74 year old client with gastroenteritis who has had 4 loose stools during the night. • C. The 65-year old with IBS who has tented turgor and dry mucous membranes. • D. The 20 year old with food poisoning who has vomited several times during the night.

Answer: B. Assess the NGT for patency

NCLEX Question • The nurse is caring for a client who had a bowel resection and is complaining of nausea. Which intervention should the nurse implement first? • A. Medicate with (ondansetron) zofran 4mg IVP over 1 minute • B. Assess the NGT for patency • C. Take the vital signs • D. Place a cool wash cloth on his forehead or neck

Answer: B. The client who was admitted with abdominal pain who suddenly has no pain A. The client with inguinal hernia repair who has not voided in 4 hours C. The client who is 4 hours post -op abdominal surgery and has no bowel sounds D. The client who is 1 day post appendectomy who is being discharged.

NCLEX question • The nurse is caring for clients on a surgical unit. Which client should the nurse assess first? • A. The client with inguinal hernia repair who has not voided in 4 hours. • B. The client who was admitted with abdominal pain who suddenly has no pain • C. The client who is 4 hours post -op abdominal surgery and has no bowel sounds • D. The client who is 1 day post appendectomy who is being discharged.

Answer: Patient A Rationale: Although the patient with Crohn's is calling the nurses' station frequently requesting pain medication, be aware that the patient with diverticulitis may be experiencing a ruptured diverticulum with peritonitis. This patient should be assessed first as the physician needs to be notified of their pain unrelieved from medication, guarding behavior, and change in mental status. The patient requesting pain medication can be delegated to another nurse to take care of while you are assessing a more urgent situation. The patient with colon cancer appears to be the most stable and can be seen last.

Of the following three patients, which one would the nurse see first: A. 78-year-old female with diverticulitis. The patient had just arrived from the emergency department at the end of the previous shift. In report, the previous nurse states that the patient had arrived 1 hour prior to shift change. In the emergency department, the patient had abdominal x-rays and CT scan completed. A nasogastric tube is in place and the patient is NPO. Pain medication has been given, although the patient continues to complain of generalized abdominal pain and is holding her abdomen. The family states that her mental status has changed with increased confusion over the past 48 hours. B. 22-year-old female with complications associated with Crohn's disease. She has a PCA pump for pain management that the patient says is not relieving her pain. She has a medication ordered for breakthrough pain in which she requests every 2 hours. It is now shift change and she is requesting her medication for breakthrough pain. She has called the nurses' station three times in the last 15 minutes. C. 60-year-old male with colon cancer who had surgery 3 days ago. The previous nurse reports that vital signs are within normal limits, and patient slept most of the night with no complaints of pain. He has had training from the Wound Ostomy Continence Nurse (WOCN) on how to care for his ostomy and is emptying it on his own. He ambulates the halls independently.

Answer: D Rationale: Jack's hemoglobin is 7.6 and hematocrit of 21.2. This probably accounts for the pulse of 133. His weight is on the low end of normal for his height but not a priority of care. His temperature is 100.5 F (38 C) due to the inflammatory process and the body's immune system at work. The blood pressure is of no concern. The nurse should expect the physician to address the potential of Jack to receive blood products for his hemoglobin and hematocrit.

On the basis of the above information, what will the nurse consider a priority to notify the provider? A. Height and weight B. Temperature C. Blood pressure D. Hemoglobin and hematocrit

Answer: C C. Epinephrine

Which of the following is secreted from the adrenal medulla? A. Aldosterone B. Cortisol C. Epinephrine D. Vasopressin

Answer: • B. BUN 50 and Creatinine 1.2

Question • A client is on sulfasalazine (Azulfidine) for ulcerative colitis. Which of the following laboratory values indicates a need for follow-up? • A. K+ 3.5 and Na+ 135 • B. BUN 50 and Creatinine 1.2 • C. Hgb 11 and Hct 33% • D. Glucose 130

Answer: C C. Large intestine

Reabsorption of the majority of the water from the gastrointestinal tract occurs in the: A. Liver B. Small intestine C. Large intestine D. Rectum

Answer: B B. Squamous

Select the type of epithelial cells that line the oral cavity. A. Basal B. Squamous C. Columnar D. Parietal

1. Which patient should the nurse assess first? Answer: Ms. Simons Rationale: Based upon Ms. Simons's history of taking oral corticosteroids daily for over 30 years, and her presenting signs of hypovolemia (decreased blood pressure and increased pulse rate), she should be seen first. While Mr. Barnett's blood pressure is greatly elevated, he has no history of cardiovascular health issues and hypovolemia is the higher priority. 2. What is the priority intervention for Ms. Simons at this time? Answer: Cortisol replacement Rationale: Definitive treatment is cortisol replacement. Most likely the provider will order parenteral replacement.

The following two patients present to the Urgent Care Clinic: Mrs. Simons is a 68-year-old female presenting with complaints of nausea and vomiting, weakness, and dizziness. Diagnosed with rheumatoid arthritis in her early 30s, she has been managing her RA with daily dose of oral cortisol (Prednisone 20 mg po daily). Mrs. Simons also has a history of angina and hypertension, managed by daily ASA 81 mg, and Atenolol. She has been unable to take her medications for the last 2 days. Vital signs are: Temp 38.2 Pulse 140 Resp 20 BP 86/50 Mr. Barnett is a 55-year-old male with no previous of history of cardiovascular problems. This morning he awoke with a severe headache unrelieved by acetaminophen or rest. He also tried resting with a cold compress to his head, and now presents to the ED as the pain seems to be getting worse. He is also complaining of nausea and has been unable to eat anything. Vital signs are: Temp 37.1 Pulse 124 Resp 28 BP 180/114 1. Which patient should the nurse assess first? 2. What is the priority intervention for Ms. Simons at this time?

Answer: B B. Anterior pituitary gland

The function of the adrenal glands is under the direct control of which structure? A. Hypothalamus B. Anterior pituitary gland C. Posterior pituitary gland D. Sympathetic nervous system

Answer: A and D Rationale: The clinical manifestations of hypercortisolism are directly related to hypersecretion of cortisol and include hyperglycemia, fluid retention, hypokalemia, abnormal fat distribution, and decreased muscle mass. The maldistribution of fats and changes in muscle are related to the effects that glucocorticoids have on fat and protein metabolism.

The nurse assesses for which clinical manifestations in the patient admitted with primary hypercortisolism? (Select all that apply.) A. Elevated serum glucose B. Elevated serum potassium C. Elevated urine specific gravity D. Elevated blood pressure E. Elevated temperature

Answer: D Rationale: Adrenocorticotropic hormone (ACTH) increases secretion of glucocorticoids and mineralocorticoids, and cortisol is the primary glucocorticoid. Growth hormone is controlled by secretion of growth hormone-releasing hormone (GHRH) and growth hormone-inhibiting hormone (somatostatin; GHIH) from the anterior pituitary gland. Epinephrine is released from the adrenal medulla. Corticotropin-releasing hormone secretion from the hypothalamus increases release of ACTH from the anterior pituitary gland.

The nurse correlates an increase in the secretion of cortisol to an increase in the release of which of the following hormones? A. Growth hormone B. Epinephrine C. Corticotropin-releasing hormone D. Adrenocorticotropic hormone

Answer: C C. Candida albicans

The nurse correlates an increased risk for oral cavity infection in older adults with which of the following organisms? A. Escherichia coli B. Staphylococcus aurous C. Candida albicans D. Pseudomonas aeruginosa

Answer: A Rationale: When the intestine protruding through an abnormal opening cannot be placed easily back into the abdominal cavity manually or by lying down, it is known as irreducible or incarcerated. If the blood supply is obstructed, it is then known as a strangulated hernia, and the patient may present with symptoms of an intestinal obstruction. This is a medical emergency, and the patient must be prepared for surgery immediately to prevent gangrene from developing. Diarrhea is not a clinical manifestation of strangulated hernias. Clinical manifestations include abdominal distension, nausea, vomiting, pain, fever and tachycardia.

The nurse correlates strangulated hernias to which finding? A. Impede blood flow of the intestines B. Result from pressure on an old surgical incision C. Lead to bouts of diarrhea D. A hernia in which contents can be placed back into place

Answer: D Rationale: Secondary to the decreased secretion of cortisol and aldosterone in patients with adrenal insufficiency, the patient is at risk for hyperkalemia and hypoglycemia. Other clinical manifestations include weakness, weight loss, fatigue, nausea, abdominal pain, gastroenteritis, and emotional lability. Hyperpigmentation of the skin and mucous membranes and decreased pubic and axillary hair (secondary to decreased secretion of sex hormones) are also observed. As the loss of sodium and water continues, the patient may develop dehydration and hypotension.

The nurse correlates which clinical manifestation to the pathophysiology of adrenal insufficiency? A. Heat intolerance B. Weight gain C. Peripheral edema D. Hypoglycemia

Answer: D Rationale: Type I hiatal hernia (sliding type) is usually acquired through an ongoing process of disruption to the gastroesophageal junction (GEJ), and is associated with GERD, chest pain, regurgitation, and dysphagia. Type II (rolling type) or paraesophageal hernias are thought to occur due to an anatomic defect that causes improper anchoring of the stomach below the diaphragm. Reflux is not usually present in patients with hiatal hernias because the LES remains secured below the diaphragm. Clinical manifestations include feeling full after eating, feelings of suffocation, and angina type chest pain.

The nurse correlates which clinical manifestation to type 1 hiatal hernia? A. Heartburn B. GERD C. Chest pain D. Anorexia

Answer: B, D, and E Rationale: Changes in release of reproductive hormones may lead to problems with sexual functioning, including erectile dysfunction in men and decreased libido in women. Bone density decrease, thinning and drying of the skin, and perineal and vaginal dryness are all associated with advancing age. Decreased metabolism is associated with decreased appetite, susceptibility to cold intolerance, changes in the quality of sleep, and decreased resting pulse rate and blood pressure.

The nurse correlates which findings to age-related changes of the endocrine system in a 55-year-old female? (Select all that apply.) A. Breast enlargement B. Decreased libido C. Increased sweating D. Vaginal dryness E. Insomnia

Answer: A, B, and C Rationale: Obesity contributes to decreased LES pressure, contributing to GERD. Substances/foods that decrease LES pressure are spicy/fatty foods, peppermint, chocolate and alcoholic beverages.

The nurse has requested a dietary consult for a patient with GERD. What statements provide useful dietary information for this patient to manage the GERD symptoms? (Select all that apply.) A. Maintain an ideal body weight. B. Avoid spicy foods. C. Avoid fatty foods. D. A glass of wine after dinner will help you relax. E. A cup of peppermint will help improve digestion.

Answer: B Rationale: After esophageal surgery, the patient is at risk for dumping syndrome, which leads to diarrhea after meals. Smaller meals, along with a decrease in complex sugars, and high in protein and fat delay gastric emptying and prevent dumping syndrome. Clear liquids are not indicated, and too much fluid may exacerbate dumping syndrome. The patient is typically provided with 6 meals per day; 8 to 10 would be too frequent.

The nurse implements which interventions to decrease the risk of dumping syndrome in the patient after esophageal resection for cancer? A. Limit diet to clear liquids only. B. Increase protein in diet. C. Increase simple sugars in the diet. D. Provide 8 to 10 small meals.

Answer: B Rationale: In patients with appendicitis, as the inflammatory process proceeds, pain is shifted to the right lower quadrant of the abdomen and becomes more severe and steady in the area of McBurney's point. When applying and releasing pressure to this area, if the patient notes increased pain when pressure is released, this is called rebound tenderness and is another indication of appendicitis. An abdominal CT may indicate inflammation or enlargement of the appendix. While a flat plate x-ray of the abdomen and serum chemistries may be ordered, they are diagnostically definitive. Laxatives are contraindicated due to the risk of perforation. There is no indication for colonoscopy, EGD, or ERCP in the patient with appendicitis.

The nurse is caring for a patient in the emergency department with abdominal pain, fever, nausea, and vomiting. The patient is suspected of having appendicitis. What intervention may the provider order to confirm diagnosis? A. Flat-plate x-ray of the abdomen, chemistry panel B. CT scan, complete blood count (CBC), abdominal assessment for rebound tenderness C. Administer a laxative to see if symptoms improve D. Colonoscopy, esophagogastroduodenoscopy (EGD), and endoscopic retrograde cholangiopancreatogram (ERCP)

Answer: A Rationale: Coughing will cause undue pressure on the surgical site and possibly lead to recurrence of the hernia. If coughing is necessary, the surgical site should be splinted with pillows to prevent pressure on the site.

The nurse is caring for a postoperative patient who has had surgery for a ventral hernia repair. The nurse is reinforcing postoperative care teaching and asks the patient to verbalize what was taught to him. Which statement requires the nurse to clarify the patient's perception of the teaching? A. "I should turn, cough, and deep breathe every 2 hours." B. "I should avoid heavy lifting until my provider tells me that I can lift again." C. "I can use ice packs and scrotal support for scrotal swelling." D. "I will observe my incision for redness, heat, swelling, and drainage. I will report these signs to my provider at once."

Answer: A Rationale: Osteoporosis may develop relative to the effects of cortisol on bone density and can increase the risk of pathologic fractures. Patients with hypercortisolism have hyperglycemia, not hypoglycemia, and hypokalemia. Muscle loss is more associated with adrenal insufficiency, not excessive cortisol.

The nurse monitors for which complication in Ms. Davis secondary to her hypercortisolism? A. Osteoporosis B. Hypoglycemia C. Muscle loss D. Hyperkalemia

Answer: A Rationale: Due to the administration of exogenous cortisol, there is decreased secretion of ACTH from the anterior pituitary gland and decreased aldosterone secretion from the adrenal cortex.

The nurse monitors for which effects of daily cortisol therapy on a patient's circulating levels of adrenocorticotropic hormone (ACTH) and aldosterone? A. Decreased ACTH, decreased aldosterone B. Decreased ACTH, increased aldosterone C. Increased ACTH, decreased aldosterone D. Increased ACTH, increased aldosterone

Answer: B Rationale: Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla. Because of excessive catecholamine secretion, pheochromocytomas may precipitate life-threatening hypertension or cardiac arrhythmias. Hypothyroidism results in sluggish metabolism. Diabetes insipidus may lead to hypovolemia and hypotension secondary to large losses of dilute urine. Patients with adrenal insufficiency are at risk for hypovolemia secondary to sodium and water losses due to lack of glucocorticoids and mineralocorticoids.

The nurse notes that which disorder places the patient at greatest risk for hypertensive crisis? A. Hypothyroidism B. Pheochromocytoma C. Diabetes insipidus D. Adrenal insufficiency

Answer: D Rationale: Females are five times more likely to develop primary hypercortisolism, and the peak incidence of hypersecreting tumors of the adrenal and pituitary glands is in the 25- to 40-year age range.

Which of the following patients is at greatest risk for primary hypercortisolism? A. A 65-year-old male B. A 56-year-old female C. A 44-year-old male D. A 28-year-old female

Answer: A Rationale: With a hiatal hernia, part of the stomach herniates up through the diaphragm and into the thorax. These patients may experience pain from reflux of ingested foods. Small frequent, bland meals eaten in an upright position help prevent reflux. Patients with hiatal hernia should not eat within two hours before lying down to sleep and should limit fluid intake with meals. H2-receptor antagonists have a slow onset of action and are most effective when taken 60 minutes before eating.

The nurse provides education to a patient who has a hiatal hernia and experiences GERD after eating. Which activity should the nurse instruct this patient to avoid? A. Lying flat after meals B. Eating small, frequent meals that are not spicy C. Sleeping with the HOB elevated 30 degrees D. Taking ranitidine on an empty stomach

Answer: B Rationale: Hypokalemia develops in the patient with hypercortisolism as cortisol leads to loss of potassium and sodium retention. There would be no rationale in limiting potassium in this patient at risk for hypokalemia.

The nurse questions which intervention in the patient diagnosed with hypercortisolism? A. Limit salt intake B. Limit foods containing potassium C. Increase weight-bearing exercises D. Avoid use of skin tape

Answer: A Rationale: There are two tools used for the diagnosis of IBS: the Rome IIV Diagnostic Criteria for Functional Gastrointestinal Disorders and the Manning criteria for the diagnosis of irritable bowel syndrome. The other tests may be used but are not as specific

The nurse recognizes which findings as diagnostic for IBS? A. Rome IIV and/or Manning criteria B. CT scan of the abdomen shows inflammatory process C. Blood urea nitrogen and creatinine are elevated D. Patient has abdominal pain and a psychiatric diagnosis

Answer: B Rationale: Females are most often affected by adrenal insufficiency, and it has a peaked incidence in people 30 to 50 years of age.

The nurse recognizes which patient is at greatest risk for adrenal insufficiency? A. A 19-year-old male B. A 35-year-old female C. A 45-year-old male D. An 80-year-old female

Answer: A Rationale: Because Crohn's disease is transmural, affecting all layers of the bowel, it can develop sinus tracts leading to fistula formation.

The patient with which condition is at the highest risk for fistula formations? A. Crohn's disease B. Ulcerative colitis C. Diverticulitis D. Irritable bowel disease

Answer: C Rationale: Bloody stools are more common with ulcerative colitis. Therefore a CBC should be ordered. Wireless capsule endoscopy evaluates the portion between what can be seen with upper GI endoscopy and the colonoscopy. Ulcerative colitis affects only the large intestine, but Crohn's disease affects anywhere from mouth to anus and must be ruled out before a surgical decision can be made. Blood, mucus, and pus are common with ulcerative colitis but not with Crohn's.

What diagnostic tests does the nurse expect to be ordered for Jack on the basis of these symptoms? A. CBC, MRI, electrolytes, stool analysis B. CT scan, MRI, chemistry panel, ERCP C. Colonoscopy, CBC, wireless capsule endoscopy, upper GI endoscopy D. BUN, creatinine, ultrasound, chest x-ray

Answer: C C. Ileum

What is the most distal section of the small intestine? A. Cecum B. Duodenum C. Ileum D. Jejunum

Answer: A Rationale: All of these are important assessments for the nurse. However, IBD often show a familial tendency and it must be noted whether there is any family history. Psychosocial history is important as IBD patients often have many psychosocial issues and symptoms are exacerbated during stress. Vital signs are important as during the inflammatory process, the patient if often febrile. The patient's previous bowel history is used to determine the onset. A is the correct answer.

What other priority information may the nurse assess in order to care for Jack? A. Psychosocial history, family history, vital signs, previous bowel history B. Vaccine history, medication history, heart rate C. Orientation status, ability to participate in sports, blood pressure D. Cranial nerves, sensation, skin assessment

Answer: A Rationale: Prilosec (Omeprazole) is a protein pump inhibitor (PPI) that is used to treat gastroesophageal reflux disease (GERD). PPIs work by blocking the last step in the gastric acid secretion and stop the acid pumps in the stomach. These medications are prescribed to be taken on a daily basis, not prn with spicy or irritating foods/beverages.

What statement by Mr. Rodriguez indicates the need for additional teaching about the prescribed Prilosec (Omeprazole)? A. "I should take this medication when I eat spicy food." B. "I need to take this medication everyday to be effective." C. "This medicine works by decreasing the acid in my stomach." D. "This medication helps heal inflammation in my esophagus."

Answer: B B. Small intestine

Where is the primary location of nutrient absorption in the gastrointestinal system? A. Stomach B. Small intestine C. Large intestine D. Pancreas

Answer: B Rationale: The patient is encouraged to eat small, frequent meals in order to decrease gastric motility and decrease diarrhea. The patient is at risk for fluid volume deficit, so fluids are not decreased. Loss of potassium may be increased with diarrhea and may require supplementation. Simple sugars increase gastric motility and can exacerbate diarrhea.

Which information does the nurse include in the teaching to Jack related to his diagnosis of ulcerative colitis? A. "Decrease fluid intake to decrease diarrhea." B. "Spread out your meals to six times per day." C. "Avoid foods high in potassium." D. "Increase your intake of simple sugars for energy."

Answer: D D. Vision

Which nursing assessment parameter for Mr. Rodriguez is not related to his current symptomatology? A. Pain B. Nutrition C. Swallowing D. Vision

Answer: B B. Sodium reabsorption

Which of the following actions is caused by secretion of mineralocorticoid? A. Increased urine output B. Sodium reabsorption C. Potassium excretion D. Decreased immune response

Answer: C Rationale: Thinning of skin, along with increased friability of skin, accompanied by fluid retention increase the chances of skin injury due to pressure or friction. Using a lift sheet to reposition a patient decreases sheer forces to the skin.

Which safety measure is most important for the nurse to institute for a patient who has Cushing's (hypercortisolism) disease? A. Padding the siderails of the patient's bed B. Assisting the patient to change positions slowly C. Using a lift sheet to change the patient's position D. Keeping suctioning equipment at the patient's bedside

Answer: A Rationale: A primary disorder of thyroid function is caused by a malfunction of the thyroid glands. Secondary thyroid disorders are related to malfunction of the anterior pituitary gland, and tertiary disorders are related to hypothalamic malfunction. Patients with brain tumors may have tumor growth in the hypothalamus (tertiary) or pituitary gland (secondary).

Which statement by a patient diagnosed with a primary thyroid disorder indicates the need for further teaching? A. "Having a brain tumor is so scary." B. "My thyroid gland is not working." C. "Now I understand why the nurse keeps measuring my neck." D. "My energy level may be affected by this disorder."

Answer: B Rationale: Patients with chronic untreated GERD are at risk of developing Barrett's esophagus.

Which statement made by Mr. Rodriguez indicates a need for an interprofessional consultation to address his risk of Barrett's esophagus? A. "I have cut back to drinking a six-pack of beer each week." B. "I cannot afford to take Prilosec for my GERD." C. "I could not afford to take my antibiotic when they told me I had H. pylori." D. "My girlfriend tells me that I have bad breath."

1. The nurse is assigned these three patients. After report, which patient would the nurse assess first? Answer: Mr. Andrews Rationale: Mr. Andrews should be assessed first as he is at greatest risk for respiratory complications related to postoperative edema. 2. The nurse is preparing to administer morning medications. Which patient would the nurse administer medications to first? Answer: Mr. Carlson and Ms. Dawson Rationale: Mr. Carlson and Ms. Dawson only have oral medication that can be administered quickly. Because Mr. Andrews requires several medications via his NG tube, the nurse could administer his medications last. In the event there were any issues with the NG tube, the other patients would have received their medications on time. Additionally, both of Mr. Andrews's NG medications are daily medications, as opposed to medications scheduled every 4-6 hours. 3. What laboratory results would the nurse need to asses prior to administering medications to Mr. Andrews? Answer: INR Rationale: While all laboratory results are important, the nurse should assess the INR prior to administering the next does of Coumadin.

You are assigned the following patients. Review their histories and orders, and answer the questions following the table. Edward Andrews 59-year-old male underwent surgical excision of a tongue lesion, along with partial removal of tongue and wide excision of soft palate tissue and lymph node biopsy. Results of the surgical tissues included T2N2M0. He is 2 days postop. He has a past medical history of hypertension and atrial fibrillation. Orders: • Bedrest with bathroom privileges • Head of bed at 60°-90° • NPO • Nasogastric tube: low intermittent suction • Vital signs Q 4 hours • Oxygen 2L/min via face tent • IV D5.45 NS with KCl 20 mEq/L at 75 cc/hour • Intake and output Q4 • Daily Labs • CBC with differential • Platelets • Arterial blood gas • Serum chemistry • Daily INR Medications: • Coumadin 2 mg QD via NGT - 1000 • Vasotec 5 mg QD via NGT - 1000 • Ancef 1 gm IV Q 6 hrs: 06; 12; 18; 24 • Morphine 2 mg IV every 2-4 hours prn pain James Carlson 35-year-old male admitted with an acute exacerbation of gastroesophageal reflux disease (GERD). He has no other chronic health issues, and other than a recent 10-pound weight loss over the last 2 months, is in relatively good health. Orders: • Activity as tolerated • Regular diet as tolerated • Vital signs QS • IV D5LR at 80 cc/hour • Intake and output QS • Daily Labs • CBC with differential • Platelets • Serum chemistry Medications: • Pepcid 20 mg PO Q 6 hours 02;10;16;22 Karen Dawson 48-year-old female who underwent a Nissen fundoplication secondary to a hiatal hernia yesterday. She is stable postoperatively. Orders: • NPO • Activity as tolerated • Vital signs Q 4 hours • IV D5.45 NS with KCl 20 mEq/L at 100 cc/hour • Intake and output QS • Daily Labs • CBC with differential • Platelets • Serum chemistry Medications: • Ancef 1 gm IV Q 6 hrs: 02; 10; 16; 22 • Pepcid 20 mg IV BID 10 and 22 • Morphine 2 mg IV every 2-4 hours prn pain 1. The nurse is assigned these three patients. After report, which patient would the nurse assess first? 2. The nurse is preparing to administer morning medications. Which patient would the nurse administer medications to first? 3. What laboratory results would the nurse need to asses prior to administering medications to Mr. Andrews?