med/surg quiz #2
A client with an esophageal tumor has difficulty swallowing and has been working with a speech-language pathologist. What assessment finding by the nurse indicates that the priority goal for this problem is being met?
Lungs clear after meals and snacks
A female client hospitalized for an unrelated problem has a large pearly-white lesion on her lip, to which she continues to apply lipstick that she will not remove for inspection. The client refuses to discuss the lesion with the nurse or health care provider. What action by the nurse is best?
work with the client to estavlish a trusting relationship
A client has dumping syndrome after a partial gastrectomy. which action by the nurse would be most helpful?
arrange a dietary consult
an older client has gastric cancer and is scheduled to have a partial gastrectomy. the family does not want the client told about her diagnosis. what action by the nurse is best?
assess family concerns and fears
A nurse assesses a client with asthma and notes bilateral wheezing, decreased pulse oxygen saturation, and suprasternal retraction on inhalation. Which actions should the nurse take?
c. Administer oxygen to keep saturations greater than 94%. e. Administer prescribed albuterol (Proventil) inhaler
A client is admitted with suspected pneumonia from the emergency department. The client went to the primary care provider a few days ago and shows the nurse the results of what the client calls an allergy test, as shown below: What action by the nurse takes priority
c. Immediately place the client on Airborne Precautions.
A nurse is caring for several older clients in the hospital that the nurse identifies as being at high risk for healthcare-associated pneumonia. To reduce this risk, what activity should the nurse delegate to the unlicensed assistive personnel (UAP)?
c. Provide oral care every 4 hours.
for which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)?
client who is pregnant
The following data relate to an older cleint who is 2 hours post op after an esophagogastrostomy: *physical assessment*: skin dry urine output 20 mL/hr NG tube patent w/ 100 mL brown drainage/hr restless *vital signs*: pulse: 128 beats/min BP: 88/50 mm Hg respiratory rate: 20 on vent cardiac output: 2.1 L/min O2 sat: 99% *physician orders*: normal saline at 75 mL/hr morhpine sulfate 2 mg IV push every hr PRN pain intake and output every hr vital signs every hr Vancomycin (Vancocin) 1 g IV Q8 What action by the nurse is best?
consult the surgeon about increased IV fluids.
A student nurse is providing care to an older client with stomatitis and dysphagia. What action by the student nurse requires the registered nurse to intervene?
Preparing to administer a viscous lidocaine gargle
A client has an NG tube after a Nissen fundoplication. The nurse answers the call lights and finds the client vomiting bright red blood with the NG tube lying on the floor. What action should the nurse take first?
Put on gloves
A client has returned to the nursing unit after an open Nissen fundoplicatio n(surgical approach to GERD). The client has an indwelling urinary catheter, an NG tube to low continuous suction, and two IVs. The nurse notes bright red blood in the NG tube. What action should the nurse take first?
Take a set of full vital signs
A client is being taught about drug therapy for Helicobacter pylori infection. What assessment by the nurse is most important?
Willingness to adhere to drug therapy
A nurse answers a clients call light and finds the client in the bathroom, vomiting large amounts of bright red blood. which action should the nurse take first?
put on gloves
A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate?
report diarrhea to your provider
A client has a pyloric obstruction and reports sudden muscle weakess. What action by the nurse takes priority?
request an ECG
A client with an esophageal tumor is having extreme difficulty swallowing. For what procedure does the nurse prepare this client?
Esophageal dilation -to provide immediate relief
A client has been taught about alginic acid and sodium bicarbonate (Gaviscon). What statement by the client indicates that the teaching has been effective?
I should take this on a full stomach.
A client has a recurrence of gastric cancer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate?
I'd like to know what you are feeling now.
A client is prescribed cetuximab (Erbitux) for oral cancer and asks the nurse how it works. What response by the nurse is best?
It blocks epidermal growth factor.
The nurse reads a clients chart and sees that the health care provider assessed mucosal erythroplasia. What should the nurse understand that this means for he client?
It's an early sign of oral cancer
A client has GERD and the provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client?
Omeprazole (Prilosec)
A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client?
Omeprazole (Prilosec)
A client has an NG tube. What action by the nursing student requires the registered nurse to intervene?
Pinning the tube to the gown so the client cannot turn the head.
A client is scheduled to have a fundoplication. What statement by the client indicates a need to review preop teaching?
After the operation, I can eat anything I want.
A client is having a temproary tracheostomy placed during surgery for oral cancer. what action by the nurse is best to relieve anxiety?
Agree on a postoperative communication method
A nurse assesses a clients oral cavity and observes the condition depicted in the photo below: what action by the nurse is the best?
Assess the client for dysphagia.
A client is in the emergency department with an esophageal trauma. The nurse palpates subcutaneous emphysema in the mediastinal area and up into the lower part of the clients neck. What action by the nurse takes priority?
Assess the clients oxygenation
A client is scheudled for a traditional esophagogastromy. All preop teaching has been completed and the client and family show good understanding. What action by the nurse is best?
Assess the clients psychosocial status.
An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client?
increase the intake of calcium and vitamin D
A client with a bleeding gastric ulcer is having a nuclear medicine scan. What action by the nurse is most appropriate?
inform the client a second scan may be needed
A client is scheduled for a total gastrectomy for gastric cancer. What preop lab result should the nurse report to the surgeon immediately?
international normalized ratio (INR): 4.2
A client had an upper gastrointestinal hemorrhage and now has an NG tube. What comfort measure may the nurse delegate to the UAP?
performing frequent oral care
The nurse is caring for a client with sialadenitis. What comfort measure may the nurse delegate to the unlicensed assistive personnel (UAP)? SATA*
-Apply warm compresses -offer fluids every hour
A nurse studying cancer knows that job relaated risks for developing oral cancer include which occupations? *SATA
-Coal miner -Metal worker -Plumber -Textile worker
A nurse has conducted a community screening event for oral cancer. Which client is the highest priorirty for referral to a dentist?
A client who smokes & drinks daily
A nurse is caring for four clients. After receiving the hand-off report, which client should the nurse see first?
Client who had a tracheostomy 4 hours ago and needs frequent suctioning.
A nurse works on the surgical unit. After receiving the hand-off report, which client should the nurse see first?
Client who had an esophagectomy with a respiratory rate of 32/min
The nurse is caring for a client with peptic ulcer disease who reports sudden onset of sharp abdominal pain. On palpation, the clients abdomen is tense and rigid. What action takes priority?
Notify the health care provider immediately
A client is 1 day post op after having Zenkers diverticula removed. The client has an NG tube to suction, and for the last 4 hours there has been no drainage. There are no specific care orders for the NG tube in place. What action by the nurse is most appropriate.
Notify the surgeon about this finding.
A client had an oral tumor removed this morning and now has a tracheostomy. What action by the nurse is the priority?
Place the client in a high-Fowlers position.
The emergency department (ED) manager is reviewing client charts to determine how well the staff performs when treating clients with community-acquired pneumonia. What outcome demonstrates that goals for this client type have been met?
a. Antibiotics started before admission
A client admitted for pneumonia has been tachypneic for several days. When the nurse starts an IV to give fluids, the client questions this action, saying I have been drinking tons of water. How am I dehydrated? What response by the nurse is best?
a. Breathing so quickly can be dehydrating.
An older adult is brought to the emergency department by a family member, who reports a moderate change in mental status and mild cough. The client is afebrile. The health care provider orders a chest x-ray. The family member questions why this is needed since the manifestations seem so vague. What response by the nurse is best?
a. Chest x-rays are always ordered when we suspect pneumonia.
A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.)
a. Chocolate c. Citrus fruits d. Peppermint e. Tomato sauce
The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.)
a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections
The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching?
a. I just joined a gym, so I hope that helps me lose weight. b. I sure hate to give up my coffee, but I guess I have to. c. I will eat three small meals and three small snacks a day. d. Sitting upright and not lying down after meals will help.
A client has a large oral tumor. What assessment by the nurse takes priority?
airway
The nurse caring for clients with gastrointestinal disorders should understand that which category best describes the mechanism of action of sucralfate (Carafate)?
mucosal barrier fortifier
A client with peptic ulcer disease asks the nurse about taking slippery elm supplements. what response by the nurse is best?
slippery elm is often used for this disorder
A client with peptic ulcer disease is in the ER and reports pain has gotten much worse over the last several days. The clients BP when lying down was 122/80 mm Hg and when standing was 98/52. What action is most appropriate?
start a large-bore IV with normal saline
After hiatal hernia repair surgery, a client is on IV pantoprazole (Protonix). The client asks the nurse why this medication is given since there is no history of ulcers. What response by the nurse is best?
it prevents stress-related ulcers
The nurse instructs a client on the steps needed to obtain a peak expiratory flow rate. In which order should these steps occur?
4. Make sure the device reads zero or is at base level. 2. Stand up (unless you have a physical disability) 1. Take as deep a breath as possible. 3. Place the meter in your mouth, and close your lips around the mouthpiece. 5. Blow out as hard and as fast as possible for 1 to 2 seconds. 6. Write down the value obtained. 7. Repeat the process two additional times, and record the highest number in your chart