Critical Care - Chapter 22

A patient is vomiting bright red blood with a hemoglobin of 13 mg/dL and a hematocrit of 40 mg/dL. This indicates to the nurse that the bleed is: (Select all that apply.) an upper gastrointestinal (GI) bleed. a new-onset bleed. an acute problem. mixed with a large amount of gastric secretions. melena.

an upper gastrointestinal (GI) bleed. a new-onset bleed. an acute problem.

Medical therapies for the patient with acute liver failure (ALF) can include all of the following except: oral neomycin for ammonia level reduction; platelet transfusion for thrombocytopenia. ibuprofen for pain control; lorazepam as an anxiolytic. lactulose retention enema for ammonia level reduction; vitamin K for coagulopathy. mannitol for ICP reduction; continuous renal replacement therapy for renal failure.

ibuprofen for pain control; lorazepam as an anxiolytic.

A nurse caring for a patient with stress-related mucosal disease (SRMD) knows that medical management will include: intravenous vasopressin, somatostatin, and octreotide to reduce portal venous pressure. intraarterial infusion of vasopressin and intraarterial embolization. endoscopic injection therapy using hypertonic saline, epinephrine, or ethanol. endoscopic injection therapy in conjunction with thermal or hemostatic clips.

intraarterial infusion of vasopressin and intraarterial embolization.

Immediate management for the patient with severe acute pancreatitis includes: intravenous crystalloids and colloids. nutritional support with TPN. drainage of pancreatic pseudocyst. electrolyte management.

intravenous crystalloids and colloids.

The leading cause of gastrointestinal hemorrhage is: stress-related erosive syndrome. esophagogastric varices. peptic ulcer disease. Mallory-Weiss tear.

peptic ulcer disease.

A patient has active gastrointestinal bleeding, and the physician has ordered a gastric lavage. The nurse appropriately educates the patient on the procedure by stating: "A large-bore nasogastric tube will be passed through your naris into your stomach. Your stomach will then be irrigated with room iced normal saline until the returned solution is clear." "A large-bore nasogastric tube will be passed through your naris into your stomach. Your stomach will then be irrigated with iced water until the returned solution is clear." "A large-bore nasogastric tube will be passed through your naris into your stomach. Your stomach will then be irrigated with room temperature normal saline until the returned solution is clear." "A large-bore nasogastric tube will be passed through your naris into your stomach. Your stomach will then be irrigated with warm water until the returned solution is clear."

"A large-bore nasogastric tube will be passed through your naris into your stomach. Your stomach will then be irrigated with room temperature normal saline until the returned solution is clear."

A patient has been prescribed sucralfate (Carafate), an antiulcer agent. The nurse knows the patient understands how to take the medication when he states: "I can take this medication at the same time I take my antacids." "I will also take a stool softener to prevent constipation from this drug." "This medication reduces the amount of gastric secretions in my stomach." "I'm glad this medication will not interact with my other medications."

"I will also take a stool softener to prevent constipation from this drug."

A patient with pancreatitis is complaining of pain that is a 9 on a scale of 10. Which of the following interventions should the nurse anticipate? (Select all that apply.) Morphine Meperidine (Demerol) Relaxation techniques Repositioning (knee chest position) Aspirin

Morphine Meperidine (Demerol) Relaxation techniques Repositioning (knee chest position)

Vasopressin is used to control gastric ulcer and variceal bleeding. The effects of vasopressin can be offset by the use of which medication? Nitroglycerin Enalapril (Vasotec) Hydralazine (Apresoline) Epinephrine (adrenalin)

Nitroglycerin

The patient recovering from gastric bypass surgery is complaining of abdominal pain (8 of 10 on the pain scale), has a temperature of 103° F, has a heart rate of 120 beats/min, and is becoming increasingly restless and anxious. What is the priority intervention? Notify the health care provider. Feed the patient lunch. Administer a beta-blocker to decrease the heart rate. Insert a nasogastric tube (NG) and connect it to low constant suction.

Notify the health care provider.

Which clinical presentation is most indicative of a patient with acute gastrointestinal hemorrhage with an approximate 33% blood loss? Pulse, 110 beats/min; respiratory rate, 24 breaths/min; orthostatic hypotension; capillary refill, less than 3 seconds; urinary output, 30 mL/hr Pulse, 120 beats/min; respiratory rate, 28 breaths/min; blood pressure, 115/50 mm Hg; capillary refill, 4 seconds; urinary output, 25 mL/hr Pulse, 130 beats/min; respiratory rate, 32 breaths/min; blood pressure, 95/40 mm Hg; cool, pale skin; urinary output, 15 mL/hr Pulse, 140 beats/min; blood pressure, 80/40 mm Hg; confusion and lethargy; urinary output, less than 5 mL/hr

Pulse, 130 beats/min; respiratory rate, 32 breaths/min; blood pressure, 95/40 mm Hg; cool, pale skin; urinary output, 15 mL/hr

A patient in liver failure questions a nurse about why he has to keep taking this laxative (lactulose) because he has diarrhea. What is the appropriate response by the nurse? I will get the doctor to stop the drug. I will get the doctor to order you something to stop the diarrhea. This drug is given to decrease bacteria in your gut and help your liver. This drug is a liver supplement.

This drug is given to decrease bacteria in your gut and help your liver.