Chapters 44 & 45 - LPN 230- week 7 Quiz

A nurse is reinforcing teaching with a group of community residents about hepatitis B. What should the nurse include in her teaching?

"A Hepatitis B immunization is given to infants and children"

A nurse is reinforcing teaching with a client who has Barrett's esophagus and is scheduled to undergo an esophagogastroduodenoscopy (EGD). What should the nurse include in her teaching?

"This procedure can determine how well the lower part of your esophagus works."

When treating a patient who has IBD with azathioprine (Imuran), what adverse effects should they report?

*Bruising *Jaundice *Sore throat *Nausea

What should checked for adverse effects when administering Sulfasalazine (Azulfidine)?

*Skin integrity *Temperature *Complete blood count

What is the most common form of hepatitis today, which has an incubation period of 10 to 40 days?

- Hepatitis A. (Hepatitis A is the most common form of hepatitis today. Formerly named infectious hepatitis, it is a short-incubation virus (10 to 40 days).

A patient is scheduled for partial gastrectomy for peptic ulcer. Which nursing action is most important after the procedure to prevent further complications?

- Measure the patient's blood serum vitamin B 12 level. (After a partial gastrectomy, there is a deficiency of intrinsic factor, which aids intestinal absorption of vitamin B 12.Thiscan result in pernicious anemia. Therefore, the nurse needs to measure the patient's blood serum vitamin B 12 level.)

The nurse is called to the room of a patient who is vomiting and notes the vomit has an appearance like coffee grounds. What should the nurse do first?

- Obtain patient's vital signs. (Coffee grounds-like vomit is indicative of blood in the stomach. The nurse should determine the patient's vital signs to determine the extent of the bleeding.)

A 70-year-old patient experiences fecal incontinence. Which gastrointestinal structure involves fecal incontinence?

- Sphincter. (In fecal incontinence, the patient loses control of the sphincter muscles around the anus, leading to involuntary excretion of bowel contents.)

A client with a bowel obstruction reports severe abdominal pain, what should indicate a possible bowel perforation has occurred?

A rigid abdomen

A patient taking Alosetron (Lotronex) for IBS should report what adverse effect?

Abdominal pain

A client taking ranitidine (Zantac) to treat GERD should taking precautions taking what OTC?

Antacids

A PCP should caution when prescribing sulfasalazine to a patient with what?

Aspirin sensitivity

What should a patient taking loperamide (Imodium) avoid?

Avoid activities that require alertness

When collecting data from a client experiencing perforation of a peptic ulcer, what manifestations should be expected?

Board like abdomen

A nurse is assisting with the care of a client who is receiving TPN therapy and has just returned to the room following PT. The nurse notes that the infusion pump for the client's TPN is turned off. After restarting the infusion pump, the nurse should monitor the client for what findings?

Diaphoresis

Lubiprostone (Amitiza) should be avoided with what symptom?

Diarrhea

The use of metoclopramide (Reglan) should be questioned in a patient taking what medication?

Digoxin (Lanoxin)

What is an adverse effect of administering IV ondansetron (Zofran) after 1 hour?

Dizziness

A client receiving a continuous feeding tube through a pump should have what intervention done?

Ensure that the head of the bead is elevated 20 degrees ( semi-Fowler position)

What disorder is contraindicated with the use of diphenoxylate/atropine (Lomotil)?

Inflammatory bowel disease

Using cimetidine (Tagamet) to treat duodenal ulcers may have what adverse effect?

Lethargy

In the admission of a client who has fulminant hepatic failure. What procedure should be expected for this client?

Liver transplant

Alosetron (Lotronex) is effective when what is reported by the patient?

One formed stool per day

A client with a PEG tube is receiving intermittent feedings. What should be done before each feeding?

Place the client in semi-Fowler position

A patient with a recent MI is given docusate sodium (Colace) to receive what therapeutic effect?

Preventing straining

For a client about to undergo a liver biopsy for a suspected malignancy, what should be monitored prior to the procedure?

Prothrombin time

What should a 4 hour postoperative laparoscopic cholecystectomy client expect?

Right shoulder pain

What medication should a patient with bleeding esophageal varices be prescribed?

Vasopressin

Which condition indicates a need for esophageal manometry?

- Dysphagia. (Esophageal manometry is used when the patient shows symptoms of achalasia, such as dysphagia. The test shows the absence of primary peristalsis.)

A client with acute pancreatitis receives treatment for 72 hours. What laboratory value is expected to return to its normal range?

Amylase

What actions should you take to administer ondansetron (Zofran) to a chemotherapy client?

*Infuse 30 minutes prior to chemotherapy *Infuse slowly over 15 minutes *Repeat dose 4 hours after chemotherapy

A nurse is caring for a patient scheduled for a laparoscopic cholecystectomy. In the patient's chart, the nurse finds signed consent forms for a laparoscopic cholecystectomy and an open cholecystectomy. What should the nurse do first?

- Do nothing. Both consent forms are necessary in case the surgery plan changes. (A consent form for both the laparoscopic and open cholecystectomies should be signed and placed in the patient's chart in case the surgery plan must be changed during the operation.)

A patient has recently had a bout of acute pancreatitis. He is asking for something to eat. Which would be most appropriate for this patient?

- Grilled chicken and a baked potato and reduced fat cheese and whole-wheat crackers. (The optimal diet for a patient who has recently had pancreatitis is a bland, low-fat, high-protein, high-carbohydrate diet. The reduced fat cheese and whole-wheat crackers and chicken and baked potato best meet these recommendations.)

Why must phenytoin (Dilantin) be spaced 2 hours apart from sucralfate (Carafate)?

Sucralfate interferes with the absorption of phenytoin

When treating a duodenal ulcer with omeprazole (Prilosec), what should you instruct the patient to do?

Swallow the capsules whole

A patient in the clinic has been diagnosed with acute viral hepatitis caused by the hepatitis B virus. The patient requests that the nurse not tell anyone about his infection. What is the best response by the nurse?

- "By law, I have to notify the Centers for Disease Control and Prevention (CDC)." (The nurse should tell the patient that the law requires all cases of viral hepatitis to be reported to the CDC.)

The nurse is counseling a patient after an upper gastrointestinal study. Which instruction is important after the test?

- "Increase your fluid intake."(The upper gastrointestinal study involves a series of radiographs of the lower esophagus, stomach, and duodenum, using barium sulfate as the contrast medium. Therefore, the patient needs to increase fluid intake after the test to expel the barium and prevent constipation.)

What is the most lethal complication of a peptic ulcer?

- Perforation. (Perforation is considered to be the most lethal complication of a peptic ulcer. This occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or the duodenum. The release of gastric acid, pancreatic enzymes, or bile causes signs and symptoms of pain, emesis, fever, hypotension, and hematemesis.)

Dimenhydrinate (Dramamine) should be avoided with what disorder?

Angle-closure glaucoma

A client who is 2 days postoperative following a gastric bypass with present bowel sounds should have what for their initial feeding?

Clear liquids

Which instruction should the nurse give a patient who is recovering from an acute episode of hepatic encephalopathy?

- "Avoid a diet rich in proteins." (Ammonia is produced after the digestion of proteins. In patients with hepatic encephalopathy, ammonia cannot be eliminated from the body; protein intake is restricted in these patients. A protein-rich diet causes an excess accumulation of ammonia in the body and is contraindicated in patients with hepatic encephalopathy.)

A nurse is providing education to a patient newly diagnosed with celiac disease. Which meal, if chosen by the patient, indicates a need for further instruction regarding the necessary diet for a patient with celiac disease?

- Spaghetti with meat sauce and whole-wheat noodles. (Whole-wheat noodles contain gluten and are prohibited for a patient with celiac disease.)

The primary health care provider prescribed cimetidine (Tagamet) to a patient with acute pancreatitis. What reason does the nurse expect behind the prescription?

- To prevent stress ulcers. (Pancreatic juice is alkaline in nature, as it has more bicarbonate ions. It maintains the gastric pH; however, in patients with pancreatitis, pancreatic activity is reduced, which may result in stress ulcers. Therefore, antacids such as cimetidine (Tagamet) should be prescribed to prevent stress ulcers.)

A client presents with chronic pancreatitis, what is a likely cause of this condition?

Alcohol use

What drug requires a specific risk-management criteria and signed treatment agreement?

Alosetron (Lotronex)

A patient with peptic ulcer disease should monitor phosphorous levels when on what drug?

Aluminum hydroxide (Amphojel)

A PCP should use caution when prescribing bisacodyl (Dulcolax) to a patient with what condition?

Anorexia nervosa

What instructions should be given to a patient taking metoclopramide (Reglan) to treat GERD?

Chew gum or suck on hard candy (Reglan can cause anti cholinergic effects)

What group is most at risk for developing hepatitis A?

Children and young adults

Which drug does the nurse expect the primary health care provider to prescribe to reduce nausea in a patient with severe liver dysfunction?

Dimenhydrinate (Dramamine) (Dimenhydrinate (Dramamine) has an easy first pass metabolism and can be cleared from the system more effectively when compared to other antiemetic drugs.)

A client with diverticulitis should be taught to eat what types of foods to prevent acute attacks?

Foods high in fiber

What is contraindicate with ranitidine?

Ketoconazole

What is the purpose of an EGD scheduled for a client?

To detect an ulceration in the stomach

A patient undergoing a paracentesis to remove ascitic fluid complains of dizziness and lightheadedness. What should the nurse do first?

- Obtain the patient's vital signs. (The patient is likely experiencing syncope because the fluid was removed too quickly. The nurse should first determine the patient's blood pressure and pulse.)

A patient who has been diagnosed with gastroesophageal reflux disease (GERD) asks the nurse why, after diet modifications and medications, the patient still has symptoms. The nurse bases the reply on which pathophysiologic change?

- Lower esophageal sphincter relaxation. (Lower esophageal sphincter relaxation leads to stomach contents moving through the sphincter up into the esophagus.)

A patient with cholecystostomy has an accidental obstruction of bile drainage. Which nursing intervention may reduce the risk for impaired skin integrity?

- Maintaining patency of the T-tube. (Maintaining patency of the T-tube is a primary nursing intervention. This promotes the draining of the obstructed bile through the opening of the T-tube.)

A patient is prescribed iopanoic acid (Telepaque) to treat a gall bladder infection. Which is the best nursing intervention to ensure the maximum therapeutic activity of the drug?

- Ensure the patient is not currently experiencing diarrhea. (Iopanoic acid (Telepaque) has an iodine dye as an active ingredient. Iodine dye is used in effectively treating oral cholecystography. The patient with diarrhea has increased elimination from the gastrointestinal tract, consequently resulting in low bioavailability of the drug. The therapeutic efficiency of the drug is therefore greatly reduced in patients with diarrhea. The patient is advised to be placed on NPO status from midnight on the day before the test is performed.)

A nurse is assisting with a paracentesis for a patient with ascites caused by cirrhosis. What should the nurse do first?

- Have the patient empty his bladder. (The patient should empty the bladder before the paracentesis to prevent puncture of the bladder. Then, the patient should be positioned sitting on the side of the bed or in high Fowler position. While the fluid is being removed, the nurse should monitor the patient for signs of syncope. After the procedure, the nurse should observe the dressing site for bleeding and drainage.)

A patient with intense pruritus asks the nurse what is causing the severe itching. The nurse informs the patient that the itching is caused by which mechanism?

- Jaundice, which causes the accumulation of bile salts under the skin. (The accumulation of bile salts causes jaundice and pruritus in the patient with liver cirrhosis.)

What instructions should be given to a client receiving dimenhydrinate (Dramamine) for motion sickness?

*Take 30-60 minutes prior to activities that trigger nausea *Avoid activities that require alertness *Increase fluid and fiber intake

What instructions should be given to a client receiving psyllium (Metamucil)for constipation?

*Take with at least 8oz of fluid *Increase fluid and fiber intake

The nurse is caring for a patient who underwent liver transplantation. Which preventive measures should the nurse instruct to prevent common respiratory complications in the patient?

- "You should cough." "You should take deep breaths." "You should use the incentive spirometer."(Common respiratory problems that occur after a liver transplantation in a patient include pneumonia, atelectasis (collapsed lung), and pleural effusions. To avoid these problems, the patient is asked to follow a few measures such as coughing, incentive spirometry, and deep breathing to prevent respiratory complications.)

Which patient has a greater chance of developing Barrett's esophagus (esophageal metaplasia)?

- A patient with untreated gastroesophageal reflux disease. (If gastroesophageal reflux disease (GERD) is left untreated, serious pathologic (precancerous) changes in the esophageal lining may develop. This condition is known as Barrett's esophagus (esophageal metaplasia).

A patient underwent a needle liver biopsy 15 minutes ago. The nurse enters the room to discover the patient sitting up in bed reading the newspaper. What is the first action the nurse should take?

- Place her on her right side. (After a needle liver biopsy it is important for the patient to lie on her right side for a minimum of 2 hours to splint the puncture site. In this position, the liver capsule is compressed against the chest wall, thereby decreasing the risk of hemorrhage or bile leak.)

A nurse is collaborating with an unlicensed assistive personnel (UAP) to care for a patient with cirrhosis of the liver. The nurse overhears the UAP say, "This patient did this to himself by being an alcoholic. I don't understand why we're trying to save him." What should the nurse do first?

- Remind the UAP that cirrhosis is also caused by factors other than alcohol. (Cirrhosis of the liver can be caused by alcohol, hepatitis viruses, gallstones, and other causes. The nurse should first remind the UAP of these other causes.)

A client in the early stages of hepatitis A should have what manifestations?

Anorexia

A client who has a history of cirrhosis with manifestations of hepatic encephalopathy should have what laboratory tests done to determine the possibility of excessive alcohol use?

Gamma-glutamyl transferase (GGT)

A nurse is caring for a client who has celiac disease. What food(s) should be removed from the meal tray?

Wheat toast

When should misoprostol (Cytotec) not be used for a patient?

When there is a positive pregnancy test

While assessing the diagnostic reports of an adult patient, the nurse finds the aspartate aminotransferase (AST) levels to be 45 units/L. Which condition does the nurse suspect in this patient?

- Acute hemolytic anemia. (AST is a liver enzyme whose normal range in adults is 0 to 35 units/L. In this patient, the AST level is 45 units/L. An increase in AST levels indicates acute hemolytic anemia.)

A nurse is caring for a patient 8 hours after a laparoscopic cholecystectomy. The patient, who was fully ambulatory before the procedure, requests to get up to go the bathroom. What action is most therapeutic for the patient?

- Assist the patient to the bathroom. (Patients should ambulate by the first night postoperatively; therefore the nurse should assist the patient to the bathroom.)

A patient comes to the clinic with complaints of intestinal cramping, diarrhea, and bloating after meals such as pasta and pizza. However, meals consisting of meat, vegetables, and a potato do not cause these symptoms. The nurse anticipates the patient will be diagnosed with which disease?

- Celiac disease. (Celiac disease is characterized by intestinal disturbances caused by the ingestion of gluten. The patient would notice a difference in symptoms between meals in which gluten is ingested (pasta, pizza), and when it is not (meat, vegetables, potato).

A patient arrives in the emergency department complaining of severe abdominal pain in the right upper quadrant that began 2 hours ago, immediately after a large meal of fatty food. The patient's heart rate and respiratory rates are elevated, and he is diaphoretic. The patient also reports new-onset clay-colored stools and dark amber urine. The nurse anticipates which diagnosis?

- Cholecystitis. (Sudden onset upper quadrant abdominal pain after a fatty meal is most likely cholecystitis caused by cholelithiasis.)

Which drug would the nurse expect the primary health care provider to prescribe before initiating a liver transplantation to ensure a safe and successful surgery?

- Cyclosporine (Gengraf) (The most common complications in the recipient of a liver transplant include rejection of the new liver tissue and infection. The use of cyclosporine (Gengraf), an effective immunosuppressant drug, has been a major factor in improving the success rate of liver transplantation. Cyclosporine (Gengraf) does not cause bone marrow suppression and does not impede wound healing.)

The largest glandular organ in the body, which functions as an accessory organ of digestion, is what?

- Liver. (The largest glandular organ in the body, which functions as an accessory organ of digestion, is the liver. It is also one of the most complex. In the adult it weighs 3 pounds.)