GI & parenteral nutrition NCLEX-Chp 56, 57, 13

92. The nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that the catheter insertions site appears reddened. The nurse should next assess which item? 1. Client's temperature 2. Expiration date on the bag 3. Time of last dressing change 4. Tightness of tubing connections

1 Rationale: Redness at catheter insertion site is a possible indication of infection. Nurse would next assess for other signs of infection. Of the options given, the temp is the next item to assess. The tightness of tubing connections should be assessed each time the PN is checked; loose connections would result in leakage, not skin redness. The expiration date on the bag is a viable option, but also should be checked at the time the solution is hung and with each shift change. The last time dressing was changed should be checked with each shift-change.

623. The nurse is planning to teach a client with GERD about substances to avoid. Which items should the nurse include on this list? Select all that apply 1. Coffee 2. Chocolate 3. Peppermint 4. Nonfat milk 5. Fried chicken 6. Scrambled eggs

1, 2, 3, 5 Rationale: Foods that decrease lower esophageal sphincter pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of GERD and should be avoided. Aggravating substances: chocolate, coffee, fired or fatty foods, peppermint, carbonated beverages, and alcohol. Options 4, and 6 do not promote this effect.

87. A client is being weaned from parenteral nutrition (PN) and is expected to begin taking solid food today. The ongoing solution rate has been 100ml/h. The nurse anticipates that which prescription regarding the PN solution will accompany the diet prescription? 1. DC the PN 2. Decrease PN rate to 50ml/h 3. Start 0.9% normal saline at 25ml/h 4. Continue current infusion rate prescriptions for PN

2 Rationale: When a client begins eating a regular diet after a period of receiving PN, the PN is gradually decreased. PN that is DC abruptly can cause hypoglycemia. Clients often have anorexia after being without food for some time, and the digestive tract also is not used to producing the digestive enzymes that are needed. Gradually decreasing the infusion rate allows the client to remain nourished during the transition to a normal diet and prevents the occurrence of hypoglycemia.

628. The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the t-tube has drained 750ml of green-brown drainage since the surgery. Which nursing intervention is most appropriate? 1. Clamp the t-tube 2. Irrigate the t-tube 3. Document the finding 4. Notify the HCP

3 Rationale: Following cholecystectomy, draining from t-tube is initially bloody and then turns a greenish-brown color. Drainage is measured as output. Amount of expected drainage will range from 500 to 1000 ml/day.

640. A client just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? 1. Folate deficiency 2. Malabsorption of fat 3. Intestinal obstruction 4. Fluid and electrolyte imbalance

4 Rationale: A frequent complications that occurs following ileostomy is fluid and electrolyte imbalance. The client requires constant monitoring of I&O to prevent this from occurring. Lossses require replacement by IV infusion until the client can tolerate a diet orally. Intestinal obstruction is a less frequent complication. Fat malabsorption and folate deficiency are complications that could occur later in the post-operative period.

88. The nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing. The client's central venous line is located in the right subclavian vein. The nurse asks the client to take which essential action during the tubing change? 1. Breathe normally 2. Turn the head to the right 3. Exhale slowly and evenly 4. Take a deep breath, hold it, and bear down

4 Rationale: Client should be asked to perform the Valsalva maneuver during tubing changes--helps avoid air embolism during tubing changes. Nurse asks client to take a deep breath, hold it, and bear down. If the IV line is on the right, the client turns their head to the left. This position increases intrathoracic pressure. Breathing normally and exhaling slowly and evenly are inappropriate and could enhance the potential for an air embolism during the tubing change.

652. A client has a new prescription for metoclopramid (Raglan). On review of the chart, the nurse identifies that this medication can be safely administered with what condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemotherapy

4 Rationale: Metoclopramide is a GI stimulant and antiemetic. BC it is a GI stimulate, it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of emesis after surgery, chemotherapy, and radiation.

619. The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Where should the nurse anticipate the location of the pain? 1. Right lower quadrant, radiating to the back 2. Right lower quadrant, radiating to the umbilicus 3. Right upper quadrant, radiating to the left scapula and shoulder 4. Right upper quadrant, radiating to the right scapula and shoulder

4 Rationale: During an acute episode of cholecystitis, the client may c/o sever right upper quadrant pain that radiates to the right scapula and shoulder. This is determined by the pattern of dermatomes in the body. The other options are incorrect.

642. The nurse is monitoring a client for the early s/s of dumping syndrome. Which findings indicate this occurrence? 1. Sweating and pallor 2. Bradycardia and indigestion 3. Double vision and chest pain 4. Abdominal cramping and pain

1 Rationale: Early manifestations of dumping syndrome occurs 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and desire to lie down.

626. HCP has determined that a client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis. 1. A 2. B 3. C 4. D

1 Rationale: Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

636. The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which symptom(s) of duodenal ulcer? 1. Weight loss 2. N/V 3. Pain relieved by food intake 4. Pain radiating down the right arm

3 Rationale: A frequent symptom of duodenal ulcer is pain that is relived by food intake. These clients generally describe the pain as a burning, heavy, sharp, or "hungry" pain that often localizes in the mid-epigastric area. The client with duodenal ulcer usually does not experience weight loss or nausea and vomiting. These symptoms are more typical in the client with a gastric ulcer.

647. An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucinations

3 Rationale: Cimetidine is a histamine receptor antagonist. Older clients are especially susceptible to CNS side effects. The most frequent of these is confusion. Less common central nervous system side effects include: headache, dizziness, drowsiness, hallucinations.

631. The nurse is providing discharge instructions following a gastrectomy and should instruct the client to take which measure to assist in preventing dumping syndrome? 1. Ambulate following a meal 2. Eat high-carbohydrate foods 3. Limit the fluids taken with meals 4. Sit in a high Fowler's position during meals

3 Rationale: Dumping syndrome refers to a constellation of vasomotor symptoms that occurs after eating, especially following a Billroth II. Early manifestations occur w/in 30 minutes of eating and include: vertigo, tachycardia, syncope, sweating, pallor, palpitations, and desire to lie down. Nurse should instruct client to decrease the amount of fluid taken at meals and to avoid high carbohydrate foods, including fluids such as fruit nectars; to assume a low Fowler's position during meals; to lie down for 30 min after eating to delay gastric emptying, and to take antispasmodics as prescribed.

644. A client has a PRN prescription for loperamide hydrochloride (imodium). For which condition should the nurse administer this medication? 1. Constipation 2. Abdominal pain 3. An episode of diarrhea 4. Hemmtest-Positive masogastric tube drainage.

3 Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in conditions such as inflammatory bowel disease. It can also be used to reduce the volume drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.

649. A client who chronically uses non steroidal anti-inflammatory drugs (NSAIDs) has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which finding is noted? 1. Resolved diarrhea 2. Relief of epigastric pain 3. Decreased platelet count 4. Decreased WBC count

2 Rationale: Client who chronically uses non steroidal anti-inflammatory drugs is prone to gastric mucosal injury. Misoporostol is a gastric protectant and is given specifically to prevent his occurrence. Diarrhea can be a side effect of the medication but is not intended effect. Options 3 and 4 are incorrect

634. The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence? 1. Dorsiflex the client's foot 2. Measure the abdominal girth 3. Ask the client to extend the arms 4. Instruct the client to lean forward

3 Rationale: Asterixis is irregular flapping movements of the fingers and wrists when the hands and arms are outstretched, palms down, wrist bent up, fingers spread. Most common and reliable sign that hepatic encephalopathy is developing. Options 1, 2, and 4 are incorrect.

618. A client has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse is assessing the client's pain. What type of pain is consistent with this diagnosis? 1. Burning and aching, located in the left lower quadrant and radiating to the hip 2. Severe and unrelenting, located in the epigastric area and radiating to the back 3. Burning and aching, located in the epigastric area and radiating to the umbilicus 4. Severe and unrelenting, located in the left lower quadrant and radiating to the groin

2 Rationale: The pain associated with acute pancreatitis is often sever and unrelenting, is located in the epigastric region, and radiates to the back. The other options are incorrect.

89. A client with parenteral nutrition (PN) infusing has disconnected the tubing from the central line catheter. The nurse assesses the client and suspects an air embolism. The nurse should immediately place the client in which position? 1. On the left side with the head lower than the feet 2. On the left side, with the head higher than the feet 3. On the right side, with the head lower than the feet. 4. On the right side, with the head higher than the feet

1 Rationale: Air embolism occurs when air enters the catheter system, such as when the system is opened for IV tubing changes of when IV tubing dc's. If air embolism is suspected, client should be placed in a left side-lying position. Head should be lower than the feet (position is used to minimize the effect of the air traveling as a bolus to the lungs by trapping it in the right side of the heart.

639. A client had a new colostomy created 2 days earlier and is beginning to pass malodorous flatus from the stoma. What is the correct interpretation by the nurse? 1. This is normal, expected event 2. The client is experiencing early signs of ischemic bowel 3. The client should not have the NG tube removed 4. This indicates inadequate preoperative bowel preparation.

1 Rationale: As peristalsis returns following creating of a colostomy, client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. W/in 72 hours of surgery, client should begin passing stool via the colostomy. Options 2, 3, and 4 are incorrect.

635. The nurse is doing an admission assessment on a client cirrhosis and notes that the ammonia level is elevated. Which diet does the nurse anticipate to be prescribed for this client? 1. Low-protein diet 2. High-protein diet 3. Moderate-fat diet 4. High-carbohydrate diet. QZA

1 Rationale: Cirrhosis is a chronic, progressive disease of the liver characterized by diffuse degeneration and destruction of hepatocytes. Most of the ammonia in the body is found in the GI tract. Protein provided by the diet is transported to the liver by the portal vein. The liver breaks down protein, which results in the formation of ammonia. If the client has hepatic encephalopathy, a low-protein diet would be prescribed.

633. The nurse is reviewing the record of a client with Cron's disease. Which stool characteristic should the nurse expect to note documented in the client's record? 1. Diarrhea 2. Chronic constipation 3. Constipation alternating with diarrhea 4. Stool constantly oozing from the rectum

1 Rationale: Crohn's disease is characterized by non bloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options 2, 3, and 4 are not characteristics of Crohn's disease.

637. A client with a hiatal hernia chronically experiences heartburn following meals. The nurse should plan to teach the client to avoid which action because it is contraindicated with a hiatal hernia? 2. Lying recumbent following meals 2. Consuming small, frequent, bland meals 3. Raising the head of the bed on 6-inch blocks 4. Taking H2 receptor antagonist medication

1 Rationale: Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm where the esophagus usually is positioned. The client usually experiences pain from reflux caused by ingestion of irritating foods, lying fat following meals or at night, and eating large or fatty meals. Relief is obtained with the intake of small, frequent, and bland meals, use of H2 receptor antagonists and antacids, elevation of the thorax following meals and during sleep.

617. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? 1. Notify the HCP 2. Administer the prescribed pain medication 3. Call and ask the operating room team to perform the surgery as soon as possible 4. Reposition the client and apply a heating pad on the warm setting to the client's abdomen

1 Rationale: On the basis of s/s presented in the question, the nurse should suspect peritonitis and notify the HCP. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis bc of the risk of rupture. Scheduling surgical time is not within the scope of nursing practice, although the HCP probably would prefer the surgery earlier than scheduled.

653. A histamine (H2) receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2 receptor antagonist? Select all that apply 1. Nizataidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (tagamet) 5. Esomeprazole (Nexium) 6. Lansoprazole (Prevacid)

1, 2, 3, 4 Rationale: H2 receptor antagonists suppers secretion of gastric acid, alleviate symptoms of heartburn, and assist in prevent complications of peptic ulcer disease. These medication also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors.

632. The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client? Select all that apply. 1. Administer antacids as prescribed 2. Encourage coughing and deep breathing 3. Administer anticholinergics as prescribed 4. Give small, frequent high calorie feedings 5. Maintain the client is a supine and flat position 6. Give meperidine (Demerol) as prescribed for pain

1, 2, 3, 6 Rationale: Client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress GI secretions. Bc abdominal pain is a prominent symptom of pancreatitis, pain medication (meperidine). Some clients experience lessened pain by assuming positions that flex the trunk, with the knees drawn up to the chest. A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may help ease the pain. Susceptible to respiratory infection bc of retroperitoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Measures such as turning, coughing, and deep breathing are instituted.

620. A client is admitted to the hospital with viral hepatitis, complaining of "no appetite" and "losing my taste for food". What instruction should the nurse give the client to provide adequate nutrition? 1. Select foods high in fat 2. Increase intake of fluids, including juices 3. Eat a good supper when anorexia is not as severe 4. Eat less often, preferably only three large meals daily

2 Rationale: Although no special diet is required to treat viral hepatitis, it is generally recommended that clients consume a low-fat diet as fat may be tolerated poorly bc of decreased bile production. Small, frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning--easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 ml/day that includes nutritional juices is also important.

627. The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? 1. Vitamin A 2. Vitamin B12 3. Vitamin C 4. Vitamin E

2 Rationale: Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of function of parietal cells. The source of intrinsic facto is lost, which results in an inability to absorb vitamin B12. This leads to development of pernicious anemia. The client is not at risk for vitamins A, C, or E deficiency.

90. Which nursing action is essential prior to initiating a new prescription for 500ml of fat emulsion (lipids) to infuse at 50 ml/h? 1. Ensure that the client does not have diabetes 2. Determine whether the client has an allergy to eggs 3. Add regular insulin to the fat emulsion, using aseptic technique 4. Contact the HCP to have a central line inserted for fat emulsion infusion.

2 Rationale: Client beginning infusions of fat emulsion must be first assessed for known allergies to eggs to prevent anaphylaxis. Egg yolk is a component of the solutions and provides emulsification. The remaining options are unnecessary are are not related to the administration of fat emulsion

98. The nurse is making initial rounds at the beginning of the shift and notes that the parenteral nutrition (PN) bag of an assigned client is empty. Which solution readily available on the nursing unit should the nurse hang until another PN solution is mixed and delivered to the nursing unit? 1. 5% dextrose in water 2. 10% dextrose in water 3. 5% dextrose in Ringer's lactate 4. 5% dextrose in 0.9% sodium chloride

2 Rationale: Client is at risk for hypoglycemia--solution containing the highest about of glucose should be hung until the new PN solution becomes available. Because PN solution contains high glucose concentrations, the 10% dextrose in water solution is the best choice.

95. A client has been discharged to home on parenteral nutrition (PN). With each visit, the home care nurse should assess which parameter most closely in monitoring this therapy? 1. Pulse and weight 2. Temperature and weight 3. Pulse and blood pressure 4. Temperature and blood pressure

2 Rationale: Client receiving PN at home should have their temperature monitored as a means of detecting infection, which is a potential complication of this therapy. An infection also could result in sepsis bc of catheter placement. Clients weight is monitored as a measure of the effectiveness of this nutritional therapy and to detect hypervolemia. Pulse and BP are important parameters to assess, but they do not relate specifically to the effects of PN.

93. The nurse is preparing to hang fat emulsion (lipids) and notes that fat globules are visible at the top of the solution and tubing be changed. What should the nurse do with the discontinued materials? 1. Rolls the bottle of solution gently 2. Obtains a different bottle of solution 3. Shakes the bottle of solution vigorously 4. Run the bottle of solution under warm water

2 Rationale: Fat emulsion (lipid) is a white, opaque solution administered IV during PN to prevent fatty acid deficiency. Nurse should examine the bottle of fat emulsion for separation of emulsion into layers of fat globules or for the accumulation of froth. The nurse should not hang a fat emulsion if any of these are observed and should return the solution to the pharmacy. Other options are inappropriate.

650. A client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Constipation

2 Rationale: Omeprazole is a proton pump inhibitor classified as an anti ulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the condition identified in options 1, 3, and 4.

96. The nurse is caring for a group of adult clients on an acute care medical-surgical nursing unit. The nurse understands that which client would be the least likely candidate for parenteral nutrition (PN)? 1. 66-year old client with extensive burns 2. 42-year old client who has had an open cholecystectomy 3. 27-year olds client with sever exacerbation of Crohn's disease 4. 35-year old client with persistent nausea and vomiting from chemotherapy

2 Rationale: PN is indicated in clients who's GI tracts are not functional or must be rested, cannot take a diet for extended periods, or have increased metabolic need. Examples: clients with burns, exacerbation or Crohn's disease, and persistent N/V due to chemotherapy. Extensive surgery, multiple fractures, septic, advanced cancer or acquired immunodeficiency syndrome. -Client with cholecystectomy would resume regular diet w/in a few days.

97. The nurse is preparing to hang the first bag of parenteral nutrition (PN) solution via the central line of an assigned client. The nurse should obtain which most essential piece of equipment before hanging the solution? 1. Urine test strips 2. Blod glucose meter 3. Electronic infusion group 4. Noninvasive blood pressure monitor

3 Rationale: Nurse must obtain an electronic infusion pump before hanging a PN solution. BC of high glucose content, use of an infusion pump is necessary to ensure that the solution does not infuse too rapidly or fall behind. BC client's BG level is monitored Q4-6 hours during admin of PN, a BG meter also will be needed, but this is not th most essential item needed before hanging the solution. Urine test steps are rarely used bc of the advent of bg monitoring. BP will be monitored, a noninvasive BP monitor is not the most essential needed for this procedure.

99. The nurse is monitoring the status of a client's fat emulsion (lipid) infusion and notes that the infusion is 1 hour behind. Which action should the nurse take? 1. Adjust the infusion rate to catch up over the next hour 2. increase the infusion rate to catch up over the next 2 hours 3. Ensure that the fat emulsion infusion rate is infusing at the prescribed rate 4. Adjust the infusion rate to run wide open until the solution is back on time.

3 Rationale: Nurse should not increase the rate of a fat emulsion to make up the difference if the infusion timing falls behind. Doing so could place the client at risk for fat overload. Increasing the rate suddenly can cause fluid overload. The same principle applies to PN or any IV infusion.

101. The nurse is caring for a restless client who is beginning nutritional therapy with parenteral nutrition (PN). The nurse should plan to ensure that which action is taken to prevent the client from sustaining injury? 1. Calculate daily intake and output 2. Monitor the temperature once daily 3. Secure all connections in the PN system 4. Monitor blood glucose levels every 12 hours.

3 Rationale: Nurse should plan to secure all connections in the tubing. This helps prevent the restless client from pulling the connections apart accidentally. Nurse should also monitor I&O, but this does not relate specifically to a risk for injury as presented in the question. Monitoring the temperature and blood glucose level does not relate to a risk for injury as presented in the question. Clients temp and blood glucose levels are monitored more frequently than the time frames identified in the options to detect signs of infection and hyperglycemia.

646. A client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having optimal intended benefit if which effect is observed? 1. Weight loss 2. Relief of heartburn 3. Reduction of steatorrhea 4. Absence of abdominal pain

3 Rationale: Pancrelipase (Pancrease, Creon) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. Med should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion

651. A client with a peptic ulcer is diagnosed with Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin (biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer" 3. "The medications will kill the bacteria and stop the acid production." 4. "These medications will coat the ulcer and decrease the acid production in my stomach.

3 Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial medications and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These meds will kill the bacteria and decrease acid production

100. A client receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse should next asses the client for the presence of which condition? 1. Thirst 2. Polyuria 3. Decreased blood pressure 4. Crackles on auscultation of the lungs

4 Rationale: Optimal weight gain when client is receiving PN is 1-2 lb/week. Client who has a weight gain of 5lb week while receiving PN is likely to have fluid retention--can result in hypervolemia. Signs: increased BP, crackles on lung auscultation, a bounding pulse, JVD, headache, and weight gain more than desired. Thirst and polyuria are associated w/hyperglycemia. Decreased BP is likely to be noted in deficient fluid volume.

629. The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? 1. Bradycardia 2. Numbness in the legs 3. N/V 5. Rigid, boardlike abdomen

4 Rationale: Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable sever pain beginning in the mid-epigastric area and spreading over the abdomen, which become rigid and boardlike. N/V may occur. Tachycardia may occur as hypovolemic shock develops. Numbness in the legs is not an associated finding.

648. A client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth 4 times a day. The nurse should schedule the medication for which times? 1. With meals and at bedtime 2. Every 6 hours around the clock 3. One hour after meals and a bedtime 4. One hours before meals and at bedtime

4 Rationale: Sucralfate is a gastric protectant. Medication should be scheduled for admin 1 hour before meals and at bedtime. Medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

91. A client is receiving parenteral nutrition (PN). The nurse monitors the client for complications of the therapy and should assess the client for which manifestations of hyperglycemia? 1. Fever, weak pulse, and thirst 2. Nausea, vomiting, and oliguria 3. Sweating, chills, and abdominal pain 4. Weakness, thirst, and increased urine output

4 Rationale: The high glucose concentration in PN places client as risk for hyperglycemia. Signs exclude: excessive thirst, fatigue, restlessness, confusion, weakness. Kussmaul's respirations , diuresis, and coma when hyperglycemia is severe. If the client has these symptoms the blood glucose level should be checked immediately. The remaining options do not identify signs specific to hyperglycemia.

94. A client receiving parenteral nutrition (PN) suddenly develops a fever. The nurse notifies the HCP, and they initially prescribes that the solution and tubing be changed. What should the nurse do with the discontinued materials? 1. Discard them in the unit trash 2. Return them to the hospital pharmacy 3. Send them to the laboratory for culture 4. Save them for return to the manufacturer

4 Rationale: When client is receiving PN develops a fever, a catheter related infection should be suspected. The solution and tubing should be changed, and the discontinued materials should be cultured for infections organisms. The other options are incorrect. Because culture for infectious organisms is necessary, the dc'd materials are not discarded or returned to the pharmacy or manufacturer.