Inflammation

A nurse plans care for a client with Crohns disease who has a haveily draining fistula. Which intervention should the nurse indicate as the priority action in this clients plan of care?

Skin protection

A client with a peptic ulcer disease asks the nurse about taking slippery elm supplements. What resoonse by the nurse is best?

Slippery elm is often used for this disorder

A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The clients blood pressure when lying down was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropritae?

Start a large-bore IV with normal saline

The nurse working with clients who have autoimmune diseases understands that what component of cell-mediated immunity is the problem?

Suppressor T cells

A nurse cares for a client with a new ileostomy. The client states, I dont think my friends will accept me with this ostomy. How should the nurse respond?

Tell me more about your concerns

The nurse is teaching a client with peptic ulcer disease (PUD) how to take sucralfate. Which statement indicates that the client understands how to take the medication?

"I shoudl take the sucralfate on an empty stomach"

Which of the following statements indicate that the client with a peptic ulcer understands the dietary modifications to follow when discharged home?

"I should avoid alcohol and caffeine"

A nurse cares for a client who is prescribed 5 mg/kg of infliximab (Remicade) intravenously. The client weighs 110 lbs and the pharmacy sypplies infliximab 100 mg/10 mL solution. How many milliliters should the nurse administer to this client __mL

25mL

A clients white blood cell count is 7500/mm3. Calculate the expected range for this clients neutrophils. __/mm3

4125-5625/mm3

The student nurse learns about risk factors for gastric cancer. Which factors does this include?

Achlorhydria; Chronic atrophic gastritis; Helicobacter pylori infection; Pernicious anemia

A nurse cares for an older adult client who has Salmonella food poisoning. The clients vital signs are heart rate: 102 beats/min, blood pressure: 98/55 mm Hg, respiratroy rate: 22 breaths/min, and oxygen saturation: 92%. Which action should the nurse complete first?

Administer intravenous fluids

A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are most appropriate?

Administer the drug through a separate IV line; Infuse pantoprazole using an IV pump; Use an in-line IV filter when infusing

For a person to be immunocompetent, which processes need to be functional and interact appropriately with each other?

Antibody-mediated immunity; Cell-mediated immunity; Inflammation

A client has gastrointestinal hemorrhage and is prescribed two units of packed red blood cells. What actions should the nurse perform prior to hanging the blood?

Ask a second nurse to double-check the blood; Prime the IV tubing with normal saline; Take and record a set of vital signs; Teach the client about reaction manifestations

A nurse cares for a client who is prescribed mesalamine (Asacol) for ulcerative colitis. The client states, I am having trouble swallowing this pill. Which action should the nurse take?

Ask the health care provider to prscibe the medciation as an enema instead

A nurse is assessing an older client for the presence of infection. The clients temperature is 97.6 F (36.4C). What response by the nurse is best?

Assess the client for more specific signs

A clinic nurse is working with an older client. What assessment is most important for preventing infections in this client?

Assessing vaccination records for booster shot needes

A client admitted with a gastric ulcer has been vomiting bright red blood. The hemoglobin is 5.1 g/dL and blood pressure is 100/50. The client and family state that their religious beliefs do not support the use of blood products and refuse blood transfusions as a treatment for the bleeding. The nurse should collaborate with the healthcare provider and family to next:

Attempt to stabilize the client through the use of fluid replacement

A nursing student learning about antibody-mediated immunity learns that the cell with the most direct role in this process begins developemtn in which tissuse or organ?

Bone marrow

For which client would the nurse suggest the provider not prescribe misoprostol (Cytotec)?

Client who is pregnant

A nurse reviews the chart of a client who has Crohns disease and a draining fistula. Which documentation should alert the nurse to urgently contact the provider for additional prescriptions?

Serum potassium of 2.6 mEq/L

A nurse assesses a client with Crohns disease and colinc strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider?

Distended abdomen

A nurse assesses a client with peritonitis. Which clinical manifestations should the nurse expect to find?

Distended abdomen; Inability to pass flatus; Decreased urine output

A nurse teaches a client who has viral gastroenteritis. Which dietary instruction should the nurse include in this clients teaching?

Drink plenty of fluids to prevent dehydration

The nurse assesses clients for the cardinal signs of inflammation. Which signs/symptoms does this include?

Edema; Redness; Warmth

A student nurse is learning about the types of different cells involved in the inflammatory response. Which prinicples does the student learn?

Eosinophils increase during allergic reactions and parasitic invasion; Macrophages can participate in many episodes of phagocytosis; Monocytes turn into macrophages after they enter body tissues; Neutrophils can only take part in one episode of phagocytosis

A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first?

Heart rate and rhythm

A nurse assesses a client who is hospitalized with an exacerbation of Crohns disease. Which clinical manifestation should the nurse expect to find?

High-pitched, rusing bowel sounds in the right lower quadrant

After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the clients understanding. Which statment by the client indicates a need for additional teaching?

I will clean my rectal area throughly with toilet paper after each stool and then apply aloe vera gel

After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assess the clients undertanding. Which statment made by the client indicates a need for additional teaching?

I will take this medication with my breakfast each morning

A client has a recurrence of gastric cnacer and is in the gastrointestinal clinic crying. What response by the nurse is most appropriate?

Id like to know what you are feeling now

An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client?

Increase 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 nurse cares for a client with ulcerative colitis. The client states, I feel like I am tired to the toilet. This disease is controlling my life. How should the nurse respond?

Lets disuss potential factors that increase your symptoms

A nurse cares for a teenage girl with a new ileostomy. The client states, I cannot go to prom with an ostomy. How should the nurse respond?

Lets talk to the enterostomal therapist about options for ostomy supplies and dress styles

The nurse is evaluating the laboratory results of a client who was recently admitted to the hospital. Which result indicates the presence of inflammation?

Leukocytosis

A nurse assesses a client with ulcerative colitis. Which complications are paired correctly with their physiologic processes?

Lower gastrointestinal bleeding Erosion of the bowel wall; Abscess formation Localized pockets of infection develop in the ulcerated bowel lining; Nonmechanical bowel obstruction Paralysis of colon resulting from colerectal cancer

A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find?

Severe, steady right lower quadrant pain

The nurse caring for clients with gastrointestinal disorders should understand that which categroy best describes the mechanism of action of sucralfate (Carafate)?

Mucosal barrier fortifier

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 nurse assesses a lcient who is recovering from an ileostomy placement. Which clinical manifestation should alert the nurse to urgently contact the health care provider?

Pale and bluish stoma

A client has an upper gastrointestinal hemorrhage and now has a nasogastric (NG) tube. What comfort mesasure may be the nruse delegate to the unlicensed assistive personnel (UAP)?

Performing frequent oral care

A client with a history of peptic ulcer disease is admitted to the hospital. Initial assessment reveals that his blood pressure is 96/60, pulse rate 120 beats/minute, and he has vomited coffee-ground-like material. Based on this assessment, what is the nurse's priority action?

Prepare to insert a nasogastric tube (NGT)

A client has a leg wound that is in the second stage of the inflammatory response. For what manifestation does the nurse assess?

Purulent drainage

A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate?

Report diarrhea to your provider

A clietn has a pyloric obstruction and reports sudden muscle weakness. What action by the nurse takes priority?

Request an electrocardiogram (ECG)

An older adult has a mild temperature, night sweats, and productive cough. The clients tuberculin test comes back negative. What action by the nurse is best?

Treat the client as if he or she has tuberculosis (TB)

After teaching a client who has a new colostomy, the nurse provides feedback based on the clients ability to complete self-care activities. Which statment should the nurse include in this feedback?

You cleaned the stoma well. Now you need to practice putting on the appliance