Exam 7

Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)? A. "You should have a good snack at bedtime." B. "Avoid foods that cause pain after you eat them." C. "You will need to remain on a bland diet." D. "High protein foods are less likely to cause pain."

Answer: B. "Avoid foods that cause pain after you eat them."

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.

Answer: B. Avoid cigarettes and smokeless tobacco. Rationale: Tobacco use greatly increases the risk for oral cancer. Acute throat infections do not increase the risk for oral cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa. Human papillomavirus (HPV) infection is associated with an increased risk, but HSV infection is not a risk factor for oral cancer.

Which information obtained by the nurse interviewing a 30-yr-old male patient is most important to communicate to the health care provider? A. The patient has a history of constipation. B. The patient has noticed blood in the stools. C. The patient had an appendectomy at age 27. D. The patient smokes a pack/day of cigarettes.

Answer: B. The patient has noticed blood in the stools. Rationale: Blood in the stools is a possible clinical manifestation of colorectal cancer and requires further assessment by the health care provider. The other patient information will also be communicated to the health care provider but does not indicate an urgent need for further testing or intervention.

A 22-yr-old female patient with an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective? A. The patient uses incontinence briefs to contain loose stools. B. The patient uses witch hazel compresses to soothe irritation. C. The patient asks for antidiarrheal medication after each stool. D. The patient cleans the perianal area with soap after each stool.

Answer: B. The patient uses witch hazel compresses to sooth irritation. Rationale: Witch hazel compresses are suggested to reduce anal irritation and discomfort. Incontinence briefs may trap diarrhea and increase the incidence of skin breakdown. Antidiarrheal medications are not given 15 to 20 times a day. The perianal area should be washed with plain water or pH balanced cleanser after each stool.

The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider? A. The bowel sounds are hyperactive in all four quadrants. B. The patient's lungs have crackles audible to the midchest. C. The nasogastric (NG) suction is returning coffee-ground material. D. The patient's blood pressure (BP) has increased to 142/84 mm Hg.

Answer: B. The patient's lungs have crackles audible to the midchest. Rationale: The patient's lung sounds indicate that pulmonary edema may be developing because of the rapid infusion of IV fluid and that the fluid infusion rate should be slowed. The return of coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when a patient has GI bleeding.

A critically ill patient with sepsis is frequently incontinent of watery stools. What action by the nurse will prevent complications associated with ongoing incontinence? A. Apply incontinence briefs. B. Use a fecal management system. C. Insert a rectal tube with a drainage bag. D. Assist the patient to a commode frequently.

Answer: B. Use a fecal management system. Rationale: Fecal management systems are designed to contain loose stools and can be in place for as long as 4 weeks without causing damage to the rectum or anal sphincters. Although incontinence briefs may be helpful, unless they are changed frequently, they are likely to increase the risk for skin breakdown. Rectal tubes are avoided because of possible damage to the anal sphincter and ulceration of the rectal mucosa. A critically ill patient will not be able to tolerate getting up frequently to use the commode or bathroom.

A 26-year-old woman is being evaluated for vomiting and abdominal pain. Which question from the nurse will be the MOST useful in determining the cause of the patient's symptoms? A. "What type of foods do you eat?" B. "Is it possible that you are pregnant?" C. "Can you tell me more about the pain?" D. "What is your usual elimination pattern?"

Answer: C. "Can you tell me more about the pain?" Rationale: A complete description of the pain provides clues about the cause of the problem. Although the nurse should ask whether the patient is pregnant to determine whether the patient might have an ectopic pregnancy and before any radiology studies are done, this information is not the most useful in determining the cause of the pain. The usual diet and elimination patterns are less helpful in determining the reason for the patient's symptoms.

A 58-year-old woman who was recently diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response by the nurse is MOST appropriate? 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."

Answer: C. "Having this new diagnosis must be very hard for you." Rationale: This response is open ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have a low survival rate, so the response, "You may have quite a few years still left to live" is misleading. The response beginning, "Thinking about dying" indicates that the nurse is not open to discussing the patient's fears of dying. The response beginning, "It is important that you be realistic" discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.

A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102° F (38.3° C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention should the nurse implement first? A. Administer IV ketorolac 15 mg for pain relief. B. Send a blood sample for a complete blood count (CBC). C. Infuse a liter of lactated Ringer's solution over 30 minutes. D. Send the patient for an abdominal computed tomography (CT) scan.

Answer: C. Infuse a liter of lactated Ringer's solution over 30 minutes. Rationale: The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion.

At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. 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.

Answer: 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. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.

A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action should the nurse take first? A. Administer bulk-forming laxatives. B. Assist the patient to sit on the toilet. C. Manually remove the impacted stool. D. Increase the patient's oral fluid intake.

Answer: C. Manually remove the impacted stool. Rationale: The initial action with a fecal impaction is manual disimpaction. The other actions will be used to prevent future constipation and impactions.

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. Curdlike plaques on the posterior tongue

Answer: C. Red patches on the buccal mucosa Rationale: A red, velvety patch suggests erythroplasia, which has a high incidence (>50%) of progression to squamous cell carcinoma. The other lesions are suggestive of acute processes (e.g., gingivitis, oral candidiasis, herpes simplex).

What is a likely finding in the nurse's assessment of a patient who has a large bowel obstruction? A. Referred back pain B. Metabolic alkalosis C. Projectile vomiting D. Abdominal distention

Answer: D. Abdominal distention Rationale: Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction.

A patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. What action should the nurse take? A. Place ice packs around the stoma. B. Notify the surgeon about the stoma. C. Monitor the stoma every 30 minutes. D. Document stoma assessment findings.

Answer: D. Document stoma assessment findings. Rationale: The stoma appearance indicates good circulation to the stoma. There is no indication that surgical intervention is needed or that frequent stoma monitoring is required. Swelling of the stoma is normal for 2 to 3 weeks after surgery. An ice pack is not needed.

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 for hospice services. B. Infuse IV fluids through a central line. C. Teach the patient about antiemetic therapy. D. Offer supplemental feedings between meals.

Answer: D. Offer supplemental feedings between meals. Rationale: The patient data indicate a poor nutritional state and improvement in nutrition will be helpful in improving the response to therapies such as surgery, chemotherapy, or radiation. Nausea and vomiting are not common clinical manifestations of stomach cancer. There is no indication that the patient requires hospice or IV fluid infusions.

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 inhibitors

Answer: D. Proton pump inhibitors Rationale: Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.

The nurse is providing preoperative teaching for a patient scheduled for an abdominal-perineal resection. Which information will the nurse include? A. The patient will need to remain on bedrest for three days after surgery. B. An additional surgery in 8 to 12 weeks will be done to create an ileal-anal reservoir. C. IV antibiotics will be started at least 24 hours before surgery to reduce the bowel bacteria. D. The site where the stoma will be located will be marked on the abdomen preoperatively.

Answer: D. The site where the stoma will be located will be marked on the abdomen preoperatively. Rationale: A wound, ostomy, continence nurse (WOCN) should select the site where the ostomy will be positioned and mark the abdomen preoperatively. The site should be within the rectus muscle, on a flat surface, and in a place that the patient is able to see. A permanent colostomy is created with this surgery. The patient will be encouraged to walk the day after surgery. Oral antibiotics (rather than IV antibiotics) are given to reduce colonic and rectal bacteria.

The nurse is reviewing a client's laboratory results which indicate hyperkalemia which is caused by acidosis. Which of the following is a compensatory mechanism for acidosis? A. Hyperventilation B. Hyperpnea C. Tachypnea D. Hypoventilation

Answer: A. Hyperventilation

After having frequent diarrhea and a weight loss of 10 lb (4.5 kg) over 2 months, a patient has a new diagnosis of Crohn's disease. What should the nurse plan to teach the patient? A. Medication use B. Fluid restriction C. Enteral nutrition D. Activity restrictions

Answer: A. Medication use Rationale: Medications are used to induce and maintain remission in patients with inflammatory bowel disease (IBD). Decreased activity level is indicated only if the patient has severe fatigue and weakness. Fluids are needed to prevent dehydration. There is no advantage to enteral feedings.

An 80-year-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? A. Metoclopramide (Reglan) B. Sucralfate (Carafate) C. Aluminum hydroxide D. Omeprazole (Prilosec)

Answer: A. Metoclopramide (Reglan)

Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? A. Navy bean soup and vegetable salad B. Whole grain pasta with tomato sauce C. Baked potato with low-fat sour cream D. Roast beef sandwich on whole wheat bread

Answer: A. Navy bean soup and vegetable salad. Rationale: A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis. Although all the choices have some fiber, the bean soup and salad will be the highest in fiber and the lowest in fat.

A patient presents to the emergency department with complaints of pain, fever, and has abdominal rigidity. Laboratory tests report a high white blood cell count. Which of the following condition is consistent with this patient's presentation? A. Peritonitis with possible sepsis B. Subphrenic abscess C. Hyperventilation D. Pelvic inflammatory disease

Answer: A. Peritonitis with possible sepsis

A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care? A. Position patient with the knees flexed. B. Avoid use of opioids or sedative drugs. C. Offer frequent small sips of clear liquids. D. Assist patient to breathe deeply and cough.

Answer: A. Position the patient with knees flexed. Rationale: There is less peritoneal irritation with the knees flexed, which will help decrease pain. Opioids and sedatives are typically given to control pain and anxiety. Preoperative patients with peritonitis are given IV fluids for hydration. Deep breathing and coughing will increase the patient's discomfort.

Following a bowel resection, a client with a nasogastric tube to low suction, complains of nausea and abdominal distention. The nurse irrigates the tube as ordered, but the irrigating solution does not return. Which of the following actions should be the priority by the nurse? A. Reposition the tube and check for placement. B. Auscultate for bowel sounds. C. Remove the tube and replace it with a new one. D. Notify the physician.

Answer: A. Reposition the tube and check for placement.

Which prescribed intervention for a patient with chronic short bowel syndrome should the nurse question? A. Senna 1 tablet daily B. Ferrous sulfate 325 mg daily C. Psyllium (Metamucil) 3 times daily D. Diphenoxylate with atropine (Lomotil) PRN loose stools

Answer: A. Senna 1 tablet daily Rationale: Patients with short bowel syndrome have diarrhea because of decreased nutrient and fluid absorption and would not need stimulant laxatives. Iron supplements are used to prevent iron-deficiency anemia, bulk-forming laxatives help make stools less watery, and opioid antidiarrheal drugs are helpful in slowing intestinal transit time.

The nurse is admitting a 67-year-old patient with new-onset steatorrhea. Which question is MOST important for the nurse to ask? A. "How much milk do you usually drink?" B. "Have you noticed a recent weight loss?" C. "What time of day do your bowels move?" D. "Do you eat meat or other animal products?"

Answer: B. "Have you noticed a recent weight loss?" Rationale: Although all the questions provide useful information, it is most important to determine if the patient has an imbalance in nutrition because of the steatorrhea.

After change-of-shift report, which patient should the nurse assess first? A. A 40-yr-old male patient with celiac disease who has frequent frothy diarrhea B. A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting C. A 30-yr-old male patient with ulcerative colitis who has severe perianal skin breakdown D. A 40-yr-old female patient with a colostomy bag that is pulling away from the adhesive wafer

Answer: B. A 30-yr-old female patient with a femoral hernia who has abdominal pain and vomiting Rationale: Pain and vomiting with a femoral hernia suggest strangulation, which will require emergency surgery. All the other patients require assessment or care but have less urgent problems.

A client is one day post-operative for hemorrhoid surgery. Which type of laxative is most appropriate for the nurse to recommend? A. A stimulant laxative B. A bulk-forming laxative C. PRN enemas D. A saline laxative

Answer: B. A bulk-forming laxative

Which information will the nurse include when teaching a patient how to avoid chronic constipation? (Select all that apply.) A. Stimulant and saline laxatives can be used regularly. B. Bulk-forming laxatives are an excellent source of fiber. C. Walking or cycling frequently will help bowel motility. D. A good time for a bowel movement may be after breakfast. E. Some over-the-counter (OTC) medications cause constipation.

Answer: B. Bulk-forming laxatives are an excellent source of fiber. C. Walking or cycling frequently will help bowel motility. D. A good time for a bowel movement may be after breakfast. E. Some over-the-counter (OTC) medications cause constipation. Rationale: Stimulant and saline laxatives should be used infrequently. Use of bulk-forming laxatives, regular early morning timing of defecation, regular exercise, and avoiding many OTC medications will help the patient avoid constipation.

Which item should nurse offer to the patient restarting oral intake after being NPO due to nausea and vomiting? A. Glass of orange juice B. Dish of lemon gelatin C. Cup of coffee with cream D. Bowl of hot chicken broth

Answer: B. Dish of lemon gelatin Rationale: Clear cool liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.

Which information will the nurse plan to teach a patient who has lactose intolerance? A. Ice cream is relatively low in lactose. B. Live-culture yogurt is usually tolerated. C. Heating milk will break down the lactose. D. Nonfat milk is tolerated better than whole milk.

Answer: B. Live-culture yogurt is usually tolerated. Rationale: Lactose-intolerant persons can usually eat yogurt without experiencing discomfort. Ice cream, nonfat milk, and milk that have been heated are all high in lactose.

A patient preparing to undergo a colon resection for cancer of the colon asks about the elevated carcinoembryonic antigen (CEA) test resuly. What should the nurse explain as the reason for the test? A. Identify any metastasis of the cancer. B. Monitor the tumor status after surgery. C. Confirm the diagnosis of a specific type of cancer. D. Determine the need for postoperative chemotherapy.

Answer: B. Monitor the tumor status after surgery. Rationale: CEA is used to monitor for cancer recurrence after surgery. CEA levels do not help to determine whether there is metastasis of the cancer. Confirmation of the diagnosis is made based on the biopsy. Chemotherapy use is based on factors other than CEA.

A patient with blunt abdominal trauma from a motor vehicle crash undergoes peritoneal lavage. If the lavage returns from brown fecal drainage, which action will the nurse plan to take NEXT? A. Auscultate the bowel sounds. B. Prepare the patient for surgery. C. Check the patient's oral temperature. D. Obtain information about the accident.

Answer: B. Prepare the patient for surgery. Rationale: Return of brown drainage and fecal material suggests perforation of the bowel and the need for immediate surgery. Auscultation of bowel sounds, checking the temperature, and obtaining information about the accident are appropriate actions, but the priority is to prepare to send the patient for emergency surgery.

A 19-year-old patient has familial adenomatous polyposis (FAP). Which action will the nurse in the gastrointestinal clinic include in the plan of care? A. Obtain blood samples for DNA analysis. B. Schedule the patient for yearly colonoscopy. C. Provide preoperative teaching about total colectomy. D. Discuss lifestyle modifications to decrease cancer risk.

Answer: B. Schedule the patient for yearly colonoscopy. Rationale: Patients with FAP should have annual colonoscopy starting at age 16 years and usually have total colectomy by age 25 years to avoid developing colorectal cancer. DNA analysis is used to make the diagnosis but is not needed now for this patient. Lifestyle modifications will not decrease cancer risk for this patient.

The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider? A. Hemoglobin (Hgb) 10.8 g/dL B. Temperature 102.1° F (38.9° C) C. Absent bowel sounds in all quadrants D. Scant nasogastric (NG) tube drainage

Answer: B. Temperature 102.1° F (38.9° C) Rationale: An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery and do not require any urgent action.

The nurse and a licensed practical/vocational nurse (LPN/VN) are working together to care for a patient who had an esophagectomy 2 days ago. Which action by the LPN/VN requires that the nurse intervene? A. The LPN/VN uses soft swabs to provide oral care. B. The LPN/VN positions the head of the bed in the flat position. C. The LPN/VN includes the enteral feeding volume when calculating intake. D. The LPN/VN encourages the patient to use pain medications before coughing.

Answer: B. The LPN/VN positions the head of the bed in the flat position. Rationale: The patient's bed should be in Fowler's position to prevent reflux and aspiration of gastric contents. The other actions by the LPN/LVN are appropriate.

A 33-yr-old male patient with a gunshot wound to the abdomen undergoes surgery, and a colostomy is formed as shown in the accompanying figure. Which information will be included in patient teaching? A. Stool will be expelled from both stomas. B. This type of colostomy is usually temporary. C. Soft, formed stool can be expected as drainage. D. Irrigations can regulate drainage from the stomas.

Answer: B. This type of colostomy is usually temporary. Rationale: A loop, or double-barrel stoma, is usually temporary. Stool will be expelled from the proximal stoma only. The stool from the transverse colon will be liquid and regulation through irrigations will not be possible.

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

Answer: C. Administer 1 L of lactated Ringer's solution. Rationale: Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly but are not the highest priorities.

A young adult has been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)? A. Auscultate the bowel sounds. B. Assess for signs of dehydration. C. Assist the patient with oral care. D. Ask the patient about the nausea.

Answer: C. Assist the patient with oral care. Rationale: Oral care is included in UAP education and scope of practice. The other actions are all assessments that require more education and a higher scope of nursing practice.

A patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the MOST rapid intervention by the nurse? A. The patient has been vomiting for 4 days. B. The patient takes antacids 8 to 10 times a day. C. The patient is lethargic and difficult to arouse. D. The patient has had a small intestinal resection.

Answer: C. The patient is lethargic and difficult to arouse. Rationale: A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information is also important to collect, but it does not require as quick action as the risk for aspiration.

What should the nurse plan to teach about to a patient with Crohn's disease who has megaloblastic anemia? A. Iron dextran infusions B. Oral ferrous sulfate tablets C. Routine blood transfusions D. Cobalamin (B12) supplements

Answer: D. Cobalamin (B12) supplements Rationale: Crohn's disease frequently affects the ileum, where absorption of cobalamin occurs. Cobalamin must be administered regularly by nasal spray or IM to correct the anemia. Iron deficiency does not cause megaloblastic anemia. The patient may need occasional transfusions but not regularly scheduled transfusions.

After several days of antibiotic therapy for pneumonia, an older hospitalized patient develops watery diarrhea. Which action should the nurse take first? A. Notify the health care provider. B. Obtain a stool specimen for analysis. C. Teach the patient about hand washing. D. Place the patient on contact precautions.

Answer: D. Place the patient on contact precautions. Rationale: The patient's history and new onset diarrhea suggest a C. difficile infection, which requires implementation of contact precautions to prevent spread of the infection to other patients. The other actions are also appropriate but can be accomplished after contact precautions are implemented.

Which assessment should the nurse perform first for a patient who just vomited bright red blood? A. Taking the blood pressure (BP) and pulse B. Measuring the quantity of emesis C. Palpating the abdomen for distention D. Auscultating the chest for breath sounds.

Answers: A. Taking the blood pressure (BP) and pulse

The nurse is caring for a client with peptic ulcer disease from H. Pylori infection and overuse of ibuprofen (NSAID). The nurse anticipates which combination of medication to eradicate the infection and the ulcer. A. PPI and metroniadzole B. H2 receptor antagonist and proton pump inhibitor (PPI) C. H2 receptor antagonist and Mylanta D. PPI and Reglan

A. Proton pump inhibitor (PPI) and metroniadzole

Which patient statement indicates the nurse's teaching about sulfasalazine (Azulfidine) for ulcerative colitis has been effective? A. "I should apply sunscreen before going outdoors." B. "The medication will be tapered if I need surgery." C. "I will need to avoid contact with people who are sick." D. "The medication prevents the infections that cause diarrhea."

Answer: A. "I should apply sunscreen before going outdoors." Rationale: Sulfasalazine may cause photosensitivity in some patients. It is not used to treat infections. Sulfasalazine does not reduce immune function. Unlike corticosteroids, tapering of sulfasalazine is not needed.

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

Answer: A. "Ranitidine decreases gastric acid secretion."

A patient with a new ileostomy asks how much it will drain. How many cups of drainage per day should the nurse explain for the patient to expect? A. 2 B. 3 C. 4 D. 5

Answer: A. 2 Rationale: After the proximal small bowel adapts to reabsorb more fluid, the average amount of ileostomy drainage is about 500 mL daily. One cup is about 240 mL.

Which patient should the nurse assess first after receiving change-of-shift report? A. A 30-yr-old patient who has a distended abdomen and tachycardia B. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours C. A 40-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours D. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool

Answer: A. A 30-yr-old patient who has a distended abdomen and tachycardia Rationale: The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients should be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses.

Which patient should the nurse first after receiving change-of-shift report? A. A patient with esophageal varices who has a rapid heart rate B. A patient with a history of gastrointestinal bleeding who has melena C. A patient with nausea who has a dose of metoclopramide (Reglan) due D. A patient who is crying after receiving a diagnosis of esophageal cancer

Answer: A. A patient with esophageal varices who has a rapid heart rate Rationale: A patient with esophageal varices and a rapid heart rate indicate possible hemodynamic instability caused by GI bleeding. The other patients do not indicate acutely life-threatening complications.

The nurse is caring for a client who has GERD. Which of the following nursing diagnoses would be a priority? A. Acute pain related to frequent episodes of gastric reflux B. Disturbed body image related to episodes of belching and reflux C. Chronic pain related to belching and flatulence D. Risk for infection related to compromised mu mucus membranes

Answer: A. Acute pain related to frequent episodes of gastric reflux

What should the nurse admitting a patient with acute diverticulitis plan for initial care? A. Administer IV fluids. B. Prepare for colonoscopy. C. Encourage a high-fiber diet. D. Give stool softeners and enemas.

Answer: A. Administer IV fluids. Rationale: A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given. These will be implemented later in the hospitalization. The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis.

A patient calls the clinic to report a new onset of severe diarrhea. What should the nurse anticipate that the patient will need to do? A. Collect a stool specimen. B. Prepare for colonoscopy. C. Schedule a barium enema. D. Have blood cultures drawn.

Answer: A. Collect a stool specimen Rationale: Acute diarrhea is usually caused by an infectious process, so stool specimens are obtained for culture and examined for parasites or white blood cells. There is no indication that the patient needs a colonoscopy, blood cultures, or a barium enema.

The nurse is assessing a patient with abdominal pain. How will the nurse document ecchymosis around the area of umbilicus? A. Cullen sign B. Rovsing sign C. McBurney sign D. Grey-Turner's sign

Answer: A. Cullen sign Rationale: Cullen sign is ecchymosis around the umbilicus. Rovsing sign occurs when palpation of the left lower quadrant causes pain in the right lower quadrant. Grey Turner's sign is bruising over the flanks. Deep tenderness at McBurney's point (halfway between the umbilicus and the right iliac crest), known as McBurney's sign, is a sign of acute appendicitis.

Which nursing action will be included in the plan of care for a 25-year-old male patient with a new diagnosis of irritable bowel syndrome (IBS)? A. Encourage the patient to express concerns and ask questions about IBS. B. Suggest that the patient increase the intake of milk and other dairy products. C. Teach the patient to avoid using nonsteroidal antiinflammatory drugs (NSAIDs). D. Teach the patient about the use of alosetron (Lotronex) to reduce IBS symptoms.

Answer: A. Encourage the patient to express concerns and ask questions about IBS. Rationale: Because psychologic and emotional factors can affect the symptoms for IBS, encouraging the patient to discuss emotions and ask questions is an important intervention. Alosetron has serious side effects and is used only for female patients who have not responded to other therapies. Although yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to symptoms in some patients. NSAIDs can be used by patients with IBS.

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 analysis

Answer: A. Endoscopy Rationale: Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding

A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider? A. Fever B. Nausea C. Joint pain D. Headache.

Answer: A. Fever Rationale: Since infliximab suppresses the immune response, rapid treatment of infection is essential. Nausea, joint pain, and headache are common side effects of the medication, but they do not indicate any potentially life-threatening complications.

A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. What information will the nurse add to a general teaching plan about UTIs in order to individualize the teaching for this patient? A. Fistulas can form between the bowel and bladder. B. Bacteria in the perianal area can enter the urethra. C. Drink adequate fluids to maintain normal hydration. D. Empty the bladder before and after sexual intercourse.

Answer: A. Fistulas can form between the bowel and bladder. Rationale: Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse.

The nurse is caring for a client who has been diagnosed with PUD from the overuse of NSAIDs. Which of the following statements is accurate regarding NSAIDs physiological effect producing pain relief? A. NSAIDs inhibit prostaglandin formation B. NSAIDs decrease release of dopamine C. NSAIDs increase formation of serotonin D. NSAIDs increase histamine formation

Answer: A. NSAIDs inhibit prostaglandin formation

A woman 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

Answer: A. Nystatin tablets Rationale: C. albicans infections are treated with an antifungal such as nystatin. Peroxide rinses would be painful. Oral saltwater rinses may be used but will not cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is indicated for gingivitis but not for Candida infection.

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 acetaminophen (Tylenol).

Answer: A. Obtain a stool specimen for culture. Rationale: Patients with bloody diarrhea should have a stool culture for Escherichia coli O157:H7. Antidiarrheal medications are usually avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications. Acetaminophen does not cause bloody diarrhea.

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 and vegetables."

Answer: 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. Raw fruits and vegetables may irritate the gastric mucosa but chewing well seems to decrease this problem and some patients may tolerate these foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little evidence to support their use.

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."

Answer: 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 other patient actions are appropriate to control symptoms of GERD.

A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). What should the nurse explain about the action of the medication? A. "It decreases nausea and vomiting." B. "It inhibits development of stress ulcers." C. "It lowers the risk for H. pylori infection." D. "It prevents aspiration of gastric contents."

Answer: B. "It inhibits development of stress ulcers." Rationale: Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.

Which information will the nurse provide for a patient with newly diagnosed gastroesophageal reflux disease (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."

Answer: 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. Peppermint will decrease lower esophageal sphincter (LES) pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distention. There is no need to make changes in physical activities because of GERD.

Which statement by a patient with chronic atrophic gastritis indicates that the nurse's 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 stomach cancer."

Answer: B. "The cobalamin injections will prevent me from becoming anemic." Rationale: Cobalamin supplementation prevents the development of pernicious anemia. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer.

After a total proctocolectomy and permanent ileostomy, the patient tells the nurse, "I cannot manage all this. I don't want to look at the stoma." What action should the nurse take? A. Reassure the patient that ileostomy care will become easier. B. Ask the patient about the concerns with stoma management. C. Postpone any teaching until the patient adjusts to the ileostomy. D. Develop a detailed written list of ostomy care tasks for the patient.

Answer: B. Ask the patient about the concerns with stoma management. Rationale: Encouraging the patient to share concerns assists in helping the patient adjust to the body changes. Acknowledgment of the patient's feelings and concerns is important rather than offering false reassurance. Because the patient indicates that the feelings about the ostomy are the reason for the difficulty with the many changes, development of a detailed ostomy care plan will not improve the patient's ability to manage the ostomy. Although detailed ostomy teaching could be postponed, the nurse should begin to offer teaching about some aspects of living with an ostomy.

Which care activity for a patient with a paralytic ileus is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? A. Auscultating for bowel sounds B. Brushing the teeth and tongue C. Assessing the nares for irritation D. Irrigating the nasogastric (NG) tube

Answer: B. Brushing the teeth and tongue Rationale: UAP education and scope of practice include patient hygiene such as oral care. The other actions require education and scope of practice appropriate to the RN.

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

Answer: B. Check the vital signs. Rationale: The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe.

What should the nurse preparing for the annual physical exam of a 45-yr-old man plan to teach the patient about? A. Endoscopy B. Colonoscopy C. Computerized tomography screening D. Carcinoembryonic antigen (CEA) testing

Answer: B. Colonoscopy Rationale: At age 45 years, persons with an average risk for colorectal cancer (CRC) should begin screening for CRC. Colonoscopy is the gold standard for CRC screening. The other diagnostic tests are not recommended as part of a routine annual physical exam at age 45 years.

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

Answer: B. Contact the surgeon. Rationale: Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion or return to surgery are needed (or both). Because the NG is draining, there is no indication that irrigation is needed. Continuing to monitor the NG drainage is not an adequate response. The patient may need morphine, but this is not the highest priority action.

A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 bloody stools a day. What should the nurse include in the plan of care? A. Administer IV metoclopramide (Reglan). B. Discontinue the patient's oral food intake. C. Administer cobalamin (vitamin B12) injections. D. Teach the patient about total colectomy surgery.

Answer: B. Discontinue the patient's oral food intake Rationale: An initial therapy for an acute exacerbation of inflammatory bowel disease (IBD) is to rest the bowel by making the patient NPO. Metoclopramide increases peristalsis and will worsen symptoms. Cobalamin (vitamin B12) is absorbed in the ileum, which is not affected by ulcerative colitis. Although total colectomy is needed for some patients, there is no indication that this patient is a candidate.

Which nursing action should be included in the postoperative 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 to 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

Answer: B. Elevate the head of the bed to at least 30 degrees. Rationale: Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.

A patient reports gas pains and abdominal distention for 2 days after a small bowel resection. Which nursing action should the nurse take? A. Administer morphine sulfate B. Encourage the patient to ambulate C. Offer the prescribed promethazine. D. Instill a mineral oil retention enema.

Answer: B. Encourage the patient to ambulate Rationale: Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an antiemetic rather than to decrease gas pains or distention.

A 49-year-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first? A. Insert a nasogastric (NG) tube. B. Infuse normal saline at 250 mL/hr. C. Administer IV ondansetron (Zofran). D. Provide oral care with moistened swabs.

Answer: B. Infuse normal saline at 250 mL/hr. Rationale: Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished after the IV fluids are initiated.

Which nursing action will the nurse include in the plan of care for a patient admitted with an exacerbation of inflammatory bowel disease (IBD)? A. Restrict oral fluid intake. B. Monitor stools for blood. C. Ambulate six times daily. D. Increase dietary fiber intake.

Answer: B. Monitor stools for blood. Rationale: Because anemia or hemorrhage may occur with IBD, stools should be assessed for the presence of blood. The other actions would not be appropriate for the patient with IBD. Dietary fiber may increase gastrointestinal motility and exacerbate the diarrhea, severe fatigue is common with IBD exacerbations, and dehydration may occur.

A 74-year-old male patient tells the nurse that growing old causes constipation, so he has been using a suppository to prevent constipation every morning. Which action should the nurse take FIRST? A. Encourage the patient to increase oral fluid intake. B. Question the patient about risk factors for constipation. C. Suggest that the patient increase intake of high-fiber foods. D. Teach the patient that a daily bowel movement is unnecessary.

Answer: B. Question the patient about risk factors for constipation. Rationale: The nurse's initial action should be further assessment of the patient for risk factors for constipation and for his usual bowel pattern. The other actions may be appropriate but will be based on the assessment.

A patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. What should the nurse teach the patient to avoid? A. Emotionally stressful situations B. Smoked foods such as ham and bacon C. Foods that cause distention or bloating D. Chronic use of H2 blocking medications

Answer: B. Smoked foods such as ham and bacon Rationale: Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. Stressful situations, abdominal distention, and use of H2 blockers are not associated with an increased incidence of stomach cancer.

Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? A. Restrict fluid intake to prevent constant liquid drainage from the stoma. B. Use care when eating high-fiber foods to avoid obstruction of the ileum. C. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. D. Change the pouch every day to prevent leakage of contents onto the skin.

Answer: B. Use care when eating high-fiber foods to avoid obstruction of the ileum. Rationale: High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies lose the absorption of water in the colon and need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible.

Which patient statement indicates 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 carbohydrate foods." C. "Vitamin supplements may prevent anemia." D. "Persistent heartburn is common after surgery."

Answer: C. "Vitamin supplements may prevent anemia." Rationale: Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery, and the patient should call the health care provider if this occurs. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome.

After change-of-shift report, which patient should the nurse assess first? A. A 42-year-old patient who has acute gastritis and ongoing epigastric pain B. A 70-year-old patient with a hiatal hernia who experiences frequent hearburn C. A 60-year-old patient with nausea and vomiting who is lethargic with dry mucosa D. A 53-year-old patient who has dumping syndrome after a recent partial gastrectomy

Answer: C. A 60-year-old patient with nausea and vomiting who is lethargic with dry mucosa Rationale: This patient is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening.

An adult with E. coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question? A. Infuse lactated Ringer's solution at 250 mL/hr. B. Monitor blood urea nitrogen and creatinine daily. C. Administer loperamide (Imodium) after each stool. D. Provide a clear liquid diet and progress diet as tolerated.

Answer: C. Administer loperamide (Imodium) after each stool. Rationale: Use of antidiarrheal agents is avoided with this type of food poisoning. IV fluids, clear oral fluids, and monitoring renal function are appropriate for dehydration.

A 53-yr-old male patient with deep partial-thickness burns from a chemical spill in the workplace has severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient's 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 patient's mealtimes.

Answer: C. Administer prescribed morphine sulfate before dressing changes. Rationale: Because the patient's 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 pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea or vomiting that occurs at other times also should be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient's nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain. However, an antiemetic may be added later if the nausea persists despite pain management.

A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient? A. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol) B. Metoclopramide (Reglan), bethanechol (Urecholine), and promethazine C. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) D. Famotidine (Pepcid), mangesium hydroxide (Mylanta), and pantoprazole (Protonix)

Answer: C. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) Rationale: The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.

A 25-yr-old male patient calls the clinic reporting diarrhea for 24 hours. Which action should the nurse take first? A. Inform the patient that testing of blood and stools will be needed. B. Suggest that the patient drink clear liquid fluids with electrolytes. C. Ask the patient to describe the stools and any associated symptoms. D. Advise the patient to use over-the-counter antidiarrheal medication.

Answer: C. Ask the patient to describe the stools and any associated symptoms. Rationale: The initial response by the nurse should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment.

A patient had an abdominal-perineal resection for colon cancer. Which nursing action is most important to include in the plan of care for the day after surgery? A. Teach about a low-residue diet. B. Monitor output from the stoma. C. Assess the perineal drainage and incision. D. Encourage acceptance of the colostomy stoma.

Answer: C. Assess the perineal drainage and incision. Rationale: Because the perineal wound is at high risk for infection, the initial care is focused on assessment and care of this wound. Teaching about diet is best done closer to discharge from the hospital. There will be very little drainage into the colostomy until peristalsis returns. The patient will be encouraged to assist with the colostomy, but this is not the highest priority in the immediate postoperative period.

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

Answer: C. Breath sounds Rationale: Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine.

A 19-yr-old woman is brought to the emergency department with a knife handle protruding from her abdomen. What should the nurse do during the initial assessment of the patient? A. Remove the knife and assess the wound. B. Determine the presence of Rovsing sign. C. Check for circulation and tissue perfusion. D. Insert a urinary catheter and assess for hematuria.

Answer: C. Check for circulation and tissue perfusion. Rationale: The initial assessment is focused on determining whether the patient has hypovolemic shock. The knife should not be removed until the patient is in surgery, where bleeding can be controlled. Rovsing sign is assessed in the patient with suspected appendicitis. Assessment for bladder trauma is not part of the initial assessment.

Four hours after a bowel resection, a 74-yr-old male patient with a nasogastric tube to suction reports nausea and abdominal distention. What should be the nurse's first action? A. Auscultate for hypotonic bowel sounds. B. Notify the patient's health care provider. C. Check for tube placement and reposition it. D. Remove the tube and replace it with a new one.

Answer: C. Check for tube placement and reposition it. Rationale: Repositioning the tube will frequently facilitate drainage. Because this is a common occurrence, it is not appropriate to notify the health care provider unless other interventions do not resolve the problem. Information about the presence or absence of bowel sounds will not be helpful in improving drainage. Removing the tube and replacing it are unnecessarily traumatic to the patient, so that would only be done if the tube was completely occluded.

Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective? A. Chocolate pudding B. Glass of low-fat milk C. Cherry gelatin with fruit D. Peanut butter and jelly sandwich

Answer: C. Cherry gelatin with fruit Rationale: Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

A 72-yr-old male patient with dehydration caused by an exacerbation of ulcerative colitis is receiving 5% dextrose in normal saline at 125 mL/hour. Which assessment finding by the nurse is most important to report to the health care provider? A. Skin is dry with tenting and poor turgor. B. Patient has not voided for the last 2 hours. C. Crackles are heard halfway up the posterior chest. D. Patient has had 5 loose stools over the previous 6 hours.

Answer: C. Crackles are heard halfway up the posterior chest. Rationale: The presence of crackles in an older patient receiving IV fluids at a high rate suggests volume overload and a need to reduce the rate of the IV infusion. The other data will be reported but are consistent with the patient's age and diagnosis and do not require a change in the prescribed treatment.

Which activity in the care of a patient with a new colostomy could the nurse delegate to unlicensed assistive personnel (UAP)? A. Document the appearance of the stoma. B. Place a pouching system over the ostomy. C. Drain and measure the output from the ostomy. D. Check the skin around the stoma for breakdown.

Answer: C. Drain and measure the output from the ostomy. Rationale: Draining and measuring the output from the ostomy is included in UAP education and scope of practice. The other actions should be implemented by LPNs or RNs.

A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first? A. Send the patient for a CT scan. B. Insert a urinary catheter to drainage. C. Infuse metronidazole (Flagyl) 500 mg IV. D. Place a nasogastric tube to intermittent low suction.

Answer: C. Infuse metronidazole (Flagyl) 500 mg IV. Rationale: Because peritonitis can be fatal if treatment is delayed, the initial action should be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated.

Which diet choice by the patient with an acute exacerbation of inflammatory bowel disease (IBD) indicates a need for more teaching? A. Scrambled eggs B. White toast and jam C. Oatmeal with cream D. Pancakes with syrup

Answer: C. Oatmeal with cream Rationale: During acute exacerbations of IBD, the patient should avoid high-fiber foods such as whole grains. High-fat foods also may cause diarrhea in some patients. The other choices are low residue and would be appropriate for this patient.

After the nurse has completed teaching a patient with newly diagnosed eosinophilic esophagitis about the management of the disease, which patient action indicates that the teaching has been effective? A. Patient orders nonfat milk for each meal. B. Patient uses the prescribed corticosteroid inhaler. C. Patient schedules an appointment for allergy testing. D. Patient takes ibuprofen (Advil) to control throat pain.

Answer: C. Patient schedules an appointment for allergy testing. Rationale: Eosinophilic esophagitis is frequently associated with environmental allergens, so allergy testing is used to determine possible triggers. Corticosteroid therapy may be prescribed, but the medication will be swallowed, not inhaled. Milk is a frequent trigger for attacks. NSAIDs are not used for eosinophilic esophagitis.

Which action will the nurse include in the plan of care for a patient who is being admitted with Clostridium difficile? A. Teach the patient about proper food storage. B. Order a diet without dairy products for the patient. C. Place the patient in a private room on contact isolation D. Teach the patient about why antibiotics will not be used.

Answer: C. Place the patient in a private room on contact isolation. Rationale: Because C. difficile is highly contagious, the patient should be placed in a private room, and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile infections. Improper food handling and storage do not cause C. difficile.

A young adult patient is admitted is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action should the nurse take? A. Assist the patient to cough and deep breathe. B. Palpate the abdomen for rebound tenderness. C. Suggest the patient lie on the side, flexing the right leg. D. Encourage the patient to sip clear, noncarbonated liquids.

Answer: C. Suggest that the patient lie on the side, flexing the right leg. Rationale: The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is often the most comfortable position. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time.

After a patient has had a hemorrhoidectomy at an outpatient surgical center, which instructions will the nurse include in discharge teaching? A. Maintain a low-residue diet until the surgical area is healed. B. Use ice packs on the perianal area to relieve pain and swelling. C. Take prescribed pain medications before you expect a bowel movement. D. Delay having a bowel movement for several days until you are well healed.

Answer: C. Take prescribed pain medications before you expect a bowel movement. Rationale: Bowel movements may be very painful, and patients may avoid defecation unless pain medication is taken before the bowel movement. A high-residue diet will increase stool bulk and prevent constipation. Delay of bowel movements is likely to lead to constipation. Warm Sitz baths rather than ice packs are used to relieve pain and keep the surgical area clean.

A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately? A. The patient reports 7/10 (0 to 10 scale) abdominal pain. B. The patient is experiencing intermittent waves of nausea. C. The patient has no breath sounds in the left anterior chest. D. The patient has hypoactive bowel sounds in all four quadrants.

Answer: C. The patient has no breath sounds in the left anterior chest. Rationale: Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The nausea and abdominal pain should be addressed, but they are not as high priority as the patient's respiratory status. Decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.

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 antiinflammatory drugs D. A history of a large recent weight gain or loss

Answer: C. Use on non-steroidal anti-inflammatory drugs Rationale: Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis.

Which question from the nurse would help determine if a patient's abdominal pain might indicate irritable bowel syndrome (IBS)? A. "Have you been passing a lot of gas?" B. "What foods affect your bowel patterns?" C. "Do you have any abdominal distention?" D. "How long have you had abdominal pain?"

Answer: D. "How long have you had abdominal pain?" Rationale: One criterion for the diagnosis of irritable bowel syndrome is the presence of abdominal discomfort or pain for at least 3 months. Abdominal distention, flatulence, and food intolerance are associated with IBS but are not diagnostic criteria.

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 from gastric acid." D. "It treats gastroesophageal reflux disease by decreasing stomach acid production."

Answer: D. "It treats gastroesophageal reflux disease by decreasing stomach acid production. Rationale: The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.

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

Answer: 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. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.

A 40-yr-old male patient has had a herniorrhaphy to repair an incarcerated inguinal hernia. Which patient teaching will the nurse provide before discharge? A. Soak in Sitz baths several times each day. B. Cough 5 times each hour for the next 48 hours. C. Avoid using acetaminophen (Tylenol) for pain. D. Apply a scrotal support and ice to reduce swelling.

Answer: D. Apply a scrotal support and ice to reduce swelling. Rationale: A scrotal support and ice are used to reduce edema and pain. Coughing will increase pressure on the incision. Sitz baths will not relieve pain and would not be of use after this surgery. Acetaminophen can be used for postoperative pain.

Which breakfast choice indicates a patient's good understanding of information about a diet for celiac disease? A. Wheat toast with butter B. Oatmeal with nonfat milk C. Bagel with low-fat cream cheese D. Corn tortilla with scrambled eggs

Answer: D. Corn tortilla with scrambled eggs Rationale: Avoidance of gluten-containing foods is the only treatment for celiac disease. Corn does not contain gluten, but oatmeal and wheat do.

A patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in the response? A. Fiber-containing laxatives may reduce the absorption of fat-soluble vitamins. B. Dietary sources of fiber should be eliminated to prevent excessive gas formation. C. Use this type of laxative to prevent constipation does not cause adverse effects. D. Large amounts of fluid should be taken to prevent impaction or bowel obstruction.

Answer: D. Large amounts of fluid should be taken to prevent impaction or bowel obstruction. Rationale: A high fluid intake is needed when patients are using bulk-forming laxatives to avoid worsening constipation. Although bulk-forming laxatives are generally safe, the nurse should emphasize the possibility of constipation or obstipation if inadequate fluid intake occurs. Although increased gas formation is likely to occur with increased dietary fiber, the patient should gradually increase dietary fiber and eventually may not need the psyllium. Fat-soluble vitamin absorption is blocked by stool softeners and lubricants, not by bulk-forming laxatives.

An 80-yr-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? A. Sucralfate (Carafate) B. Aluminum hydroxide C. Omeprazole (Prilosec) D. Metoclopramide (Reglan)

Answer: D. Metoclopramide (Reglan) Rationale: Metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations. Hallucinations are not a side effect of proton pump inhibitors, mucosal protectants, or antacids.

A patient who takes a non-steroidal anti-inflammatory drug (NSAID) daily for the management of severe rheumatoid arthritis has recently developed melena. What should the nurse anticipate teaching the patient? A. Substitution of acetaminophen (Tylenol) for the NSAID B. Use of enteric-coated NSAIDs to reduce gastric irritation C. Reasons for using corticosteroids to treat the rheumatoid arthritis D. Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa

Answer: D. Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa Rationale: Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating rheumatoid arthritis.

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.

Answer: D. Treatment may include endoscopic procedures Rationale: Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Keeping the head elevated after eating will improve esophageal emptying. A semisoft diet is recommended to improve esophageal emptying. Patients are advised to drink fluids with meals.

Which precaution is most important for the nurse to teach a patient who is prescribed an antacid? A. "Drink plenty of soda after taking this medication" B. "Avoid using extra pepper on your food while taking this drug" C. "Take this drug at least 2 hours before or after any other drug" D. "If you become constipated, stop taking the antacid completely"

Answer: C. "Take this drug at least 2 hours before or after any other drug"

The nurse is caring for a patient receiving an enteral feeding and the nurse is concerned that the patient is experiencing Dumping Syndrome due to the rapid infusion of the bolus feeding. Which of the following signs and symptoms are suggestive of Dumping Syndrome? A. Diaphoresis B. Hallucinations C. Constipation D. Abdominal Cramps E. Palpitations

Answers: A. Diaphoresis D. Abdominal Cramps E. Palpitations

Health teaching for a patient with GERD is directed toward decreasing lower esophageal sphincter pressure and irritation. The nurse instructs the client to do which of the following? Select all that apply. A. Drink three 8 oz. glasses of milk daily to coat the esophagus. B. Eat 1 hour before bedtime so there will be food in the stomach overnight to absorb excess acid. C. Elevate the upper body on pillows to achieve a 30 degree angle. D. Do not lay supine for 2-3 hours after a meal.

Answers: C. Elevate the upper body on pillows to achieve a 30 degree angle. D. Do not lay supine for 2-3 hours after a meal.