nurs 321 exam 1

how long is everything for enteral tube feedings good for?

24 hours; change if its been longer

bicarbonate in metabolic alkalosis

above 26, high.

A nurse obtains assessment data on a client who had bariatric surgery today. Which finding does the nurse report to the surgeon immediately? A. Bowel sounds are not audible in all quadrants. B. Client's skin under the panniculus is excoriated. C. The client reports pain when being repositioned .D. Urine output total is 15 mL for the past 2 hours.

.D. Urine output total is 15 mL for the past 2 hours. Rationales: Incorrect: Inaudible bowel sounds may require nursing interventions but do not require immediate intervention by the surgeon. On the day of surgery, they will probably be absent normally for some time. Incorrect: Excoriated skin under the panniculus may require nursing interventions but does not require immediate intervention by the surgeon. Incorrect: Subjective reports of pain may require nursing interventions but do not require immediate intervention by the surgeon, as does the scant urine output. Correct: Oliguria may indicate severe postoperative complications such as anastomotic leaks or acute kidney failure.

The nurse is teaching a group of teenage boys who are on a baseball team about the risks of chewing tobacco. Which of the following should the nurse instruct the teenagers to report to their parents and physicians? Select all that apply. 1. Dysphagia. 2. Sensitive teeth. 3. Unexplained mouth pain. 4. Lump in the neck. 5. Decreased saliva. 6. White patch on the mucosa.

1, 3, 4, 6. Chewing tobacco has become a more common practice among teenagers. It is important that they understand that this increases their risk for oral cancer. They should be instructed to inspect their mouth frequently and report any observed lesions or other changes in the oral mucosa. Signs and symptoms that are potential indicators of oral cancer are dysphagia, unexplained mouth pain, a lump in the neck, and white patches on the mucosa (leukoplakia). Other indications may be a painless mouth ulcer, a reddened patch (erythroplasia), and rough patches on the mucosa. Sensitive teeth and decreased saliva are not associated with oral cancer.

A client presents to the emergency department with upper GI bleeding and is in moderate distress. In planning care, what is the priority nursing action for this client? 1. assessment of vital signs 2. completion of abdominal examination 3. insertion of the prescribed nasogastric tube 4. thorough investigation of precipitating causes

1. assessment of vital signs

The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? 1. sweating and pallor 2. bradycardia and indigestions 3. double vision and chest pain 4. abdominal cramping and pain

1. sweating and pallor

"The nurse is caring for an adult client diagnosed with gastroesophageal reflux disease(GERD). Which condition is the most common comorbid disease associated with GERD? 1.Adult-onset asthma.2.Pancreatitis.3.Peptic ulcer disease.4.Increased gastric emptying

1.Adult-onset asthma

The nurse is assessing the client diagnosed with chronic gastritis. Which symptom(s) support this diagnosis? 1. Rapid onset of midsternal discomfort 2. Epigastric pain relieved by eating food 3. Dyspepsia and hematemesis 4. Nausea and projectile vomiting

2. Epigastric pain relieved by eating food

What response should a nurse offer to a client who asks why he's having a vagotomy to treat his ulcer? 1. To repair a hole in the stomach 2. to reduce the ability of the stomach to produce acid 3. to prevent the stomach from sliding into the chest 4. to remove a potentially malignant lesion in the stomach

2. to reduce the ability of the stomach to produce acid

"The nurse is teaching the patient a client with a peptic ulcer discharge instructions. The client asks the nurse which type of analgesic he may take. Which of the following responses by the nurse would be most accurate?" 1. Aspirin 2. Acetaminophen 3. Naproxen 4. Ibuprofen

2.Acetaminophen is recommended for pain relief because it does no promote irritation of the mucosa. Aspirin, and nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen, may cause irritation of the mucosa and subsequent bleeding

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 for which signs/symptoms of duodenal ulcer? 1. weight loss 2. nausea and vomiting 3. pain relieved by food intake 4. pain radiating down the right arm

3. pain relieved by food intake

During the assessment of a client's mouth, the nurse notes the absence of saliva. The client has pain in the area of the ear. The client has been nothing-by-mouth (NPO) for several days because of the insertion of a nasogastric tube. Based on these findings, the nurse suspects that the client may be developing which of the following mouth conditions?1. Stomatitis.2. Oral candidiasis.3. Parotitis.4. Gingivitis.

3. The lack of saliva, pain near the area of the ear, and the prolonged NPO status of the client should lead the nurse to suspect the development of parotitis, or inflammation of the parotid gland. Parotitis usually develops in cases of dehydration combined with poor oral hygiene or when clients have been NPO for an extended period. Preventive measures include the use of sugarless hard candy or gum to stimulate saliva production, adequate hydration, and frequent mouth care. Stomatitis (inflammation of the mouth) produces excessive salivation and a sore mouth. Oral candidiasis (thrush) causes bluish white mouth lesions. Gingivitis can be recognized by the inflamed gingiva and bleeding that occur during toothbrushing.

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. Nausea and vomiting 4. A rigid, board-like abdomen

4. A rigid, board-like abdomen Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the mid epigastric area and spreading over the abdomen, which become rigid and board-like

The nurse is planning to teach a client with GERD about substances that will increase the LES pressure.Which item shoud the nurse include on this list. 1. Coffee 2. Chocolate 3. Fatty Foods 4. Nonfat MIlk

4. Nonfat MIlk the other foods decrease LES pressure

How much residual is too much?

500 or 250 x2

When assessing a client during a routine checkup, the nurse reviews the history and notes that the client had aphthous stomatitis at the time of the last visit. Aphthous stomatitis is best described as: A canker sore of the oral soft tissues An acute stomach infection Acid indigestion

A canker sore of the oral soft tissues

A group of nursing students are studying together. They are discussing the differences between parenteral and enteral nutrition. Which statement, if made by one of the students, indicates further instruction is needed? A) "Parenteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube." B) "Enteral nutrition is preferred because it is less expensive than parenteral nutrition and maintains functioning of the gut." C) "An example of the parenteral route is subcutaneous or IM injections, or the IV route." D) "Gastric feedings may be given to patients with a low risk of aspiration. If there is a risk of aspiration, jejunal feeding is the preferred method.

A) "Parenteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube."

Which of the following patients may benefit from enteral nutrition? (Select all that apply.) A) A patient who has a brain injury B) A patient with oral cancer C) A patient with paralytic ileus D) A patient with burns of the lower extremities

A) A patient who has a brain injury B) A patient with oral cancer D) A patient with burns of the lower extremities

Identify the appropriate times to verify enteral tube placement by pH testing. (Select all that apply.) A) Before each intermittent feeding B) At least once every 6 hours during continuous feedings C) Before administration of medications through the tube D) After administration of medications through the feed

A) Before each intermittent feeding B) At least once every 6 hours during continuous feedings C) Before administration of medications through the tube

A patient had an NG feeding tube inserted 1 week ago. You notice that the patient's nasal mucosa is inflamed, and the patient complains of pain at the site of insertion. The other naris appears patent with intact skin. What is the best action to take at this time? A) Call the physician; get an order to remove the feeding tube and insert a new feeding tube in the opposite naris. B) Remove the feeding tube and reinsert it in the opposite naris. C) Apply triple antibiotic ointment at the site of insertion and leave the tube in place. D) Medicate the patient for pain and stop using the feeding tube.

A) Call the physician; get an order to remove the feeding tube and insert a new feeding tube in the opposite naris.

Which of the following are accurate statements related to the use of water and administering medication through a feeding tube? (Select all that apply.) A) Cold water should be avoided as it may cause abdominal cramping. B) Tap water as hot as possible should be used to enable the medications to dissolve. C) The feeding tube should be flushed with 10 mL of water after each medication is administered. D) Patients who receive tube feedings do not require water. E) The feeding tube should be flushed with 30 to 60 mL of water after the last medication. F) Any time water is administered through the feeding tube, the amount should be documented on the intake and output record.

A) Cold water should be avoided as it may cause abdominal cramping. C) The feeding tube should be flushed with 10 mL of water after each medication is administered. E) The feeding tube should be flushed with 30 to 60 mL of water after the last medication. F) Any time water is administered through the feeding tube, the amount should be documented on the intake and output record.

Identify signs and symptoms of accidental respiratory migration of a feeding tube. (Select all that apply.) A) Coughing B) Choking C) Cyanosis D) Sore throat E) Distention

A) Coughing B) Choking C) Cyanosis

You are attempting to administer medication through a feeding tube but are unable to do so because of a blockage in the tube. What action(s) should you take? (Select all that apply.) A) For a newly inserted tube, notify physician and obtain x-ray confirmation of positioning. B) Clamp the tube and try again at a later time. C) For an established tube, attempt to flush tube with a large-bore syringe and warm water. D) Soak the end of the tube in warm water. E) If unable to flush, contact physician for replacement of tube and potential need to reroute medication .F) Have the patient place the chin to the chest and swallow

A) For a newly inserted tube, notify the physician and obtain x-ray confirmation of positioning. C) For an established tube, attempt to flush tube with a large-bore syringe and warm water. E) If unable to flush, contact a physician for replacement of tube and the potential need to reroute medication

The patient is presently receiving intermittent tube feedings of 120 mL every 6 hours. The physician's orders state: Jevity formula feeding 240 mL every 6 hours per feeding tube, increase per patient tolerance. Which of the following assessment data indicate patient intolerance of the tube feeding and therefore inability of the rate to be increased? (Select all that apply.) A) Diarrhea B) Abdominal distention and discomfort C) Nausea D) Flatulence E) Thirst F) Residual volume greater than 200 mL

A,B,C,F

You have inserted an NG feeding tube. The patient vomited during insertion and continues to gag. What action(s) should you take? (Select all that apply.) A) Suction airway as needed. B) Place patient in high-Fowler's position. C) Remove feeding tube. D) Position patient on side. E) Contact physician for possible chest x-ray .F) Have patient sip ice water.

A,C,D,E

Which clinical manifestation would cause the nurse to suspect that the client is diagnosed with systemic lupus erythematosus? A Joint edema and tenderness B Red, burning, tearing eyes C Chest tightness with wheezing on expiration D Fever and night sweats

A- Joint edema and tendernessClinical features of systemic lupus erythematosus involve multiple body systems. When the musculoskeletal system is involved, the client exhibits joint tenderness, edema, and morning stiffness. Eyes that are red, burning, and tearing are commonly associated with allergic rhinitis (i.e., hay fever). Chest tightness and wheezing on expiration are associated with allergic asthma. Fever and night sweats are manifestations of acquired immunodeficiency syndrome.

An experienced nurse is observing a new nurse teaching the client about TPN. Which statement indicates that the new nurse needs additional orientation regarding the administration of TPN? •A. "A gastrostomy tube will be inserted through the abdominal wall into your stomach to administer your TPN." •B. "Your blood glucose will be monitored frequently because the TPN has a high concentration of dextrose." •C. "Although an infusion pump will be used to administer the TPN solution, you can still ambulate with assistance." •D. "The TPN provides nutrients of proteins, carbohydrates, fats, electrolytes, vitamins, and trace minerals."

A. "A gastrostomy tube will be inserted through the abdominal wall into your stomach to administer your TPN." •Parenteral nutrition provides nutrients by the IV route, not through a gastrostomy tube.

On initial assessment of an older patient, the nurse knows to look for certain types of diseases because which immunologic response increases with age? A. Autoimmune response B. Cell-mediated immunity C. Hypersensitivity response D. Humoral immune response

A. Autoimmune response

A nurse is monitoring a client who is receiving an intravenous fat emulsion (IVFE) nutritional supplement. What action does the nurse take in the event that the client develops fever, increased triglycerides, and clotting problems? A. Discontinues the IVFE infusion B. Documents the findings and continues to monitor C. Slows the rate of flow of the IVFE infusion D. Switches the infusion to total parenteral nutrition (TPN) infusion

A. Discontinues the IVFE infusion For clients receiving fat emulsions, monitor for manifestations of fat overload syndrome, especially in those who are critically ill. These manifestations include fever, increased triglycerides, clotting problems, and multi-system organ failure. Discontinue the IVFE infusion, and report any of these changes to the health care provider immediately if this complication is suspected.

The nurse is initiating an IV infusion of lactated Ringer's (LR) for the client in shock. What is the purpose of LR for this client? •A. Increase fluid volume and urinary output. •B. Draw water from the cells into the blood vessels. •C. Provide dextrose and nutrients to prevent cellular death. •D. Replace potassium and magnesium for cardiac stabilization.

A. Increase fluid volume and urinary output.

The nurse provides education to a patient who has a hiatal hernia and experiences GERD after eating. Which activity should the nurse instruct this patient to avoid? A. Lying flat after meals B. Eating small, frequent meals that are not spicy C. Sleeping with the HOB elevated 30 degrees D. Taking ranitidine on an empty stomach

A. Lying flat after meals

The nurse has requested a dietary consult for a patient with GERD. What statements provide useful dietary information for this patient to manage the GERD symptoms? (Select all that apply.) A. Maintain an ideal body weight. B. Avoid spicy foods. C. Avoid fatty foods. D. A glass of wine after dinner will help you relax. E. A cup of peppermint will help improve digestion.

A. Maintain an ideal body weight. B. Avoid spicy foods. C. Avoid fatty foods.

Which clinical manifestations will the nurse expect to find when taking care of a patient diagnosed with oral cancer? (Select all that apply.) A. Pain radiating to the ear B. Otitis media C. Leukoplakia D. Presence of HPV E. Nasal polyposis

A. Pain radiating to the ear C. Leukoplakia D. Presence of HPV E. Nasal polyposis

A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level. C. Performing a fecal occult blood test and administering IV calcium gluconate. D. Starting parenteral nutrition and placing the patient in high-Fowler's position

A. Providing IV fluids and inserting a nasogastric tube

•The client with a BMI of 30 is attending a health promotion program at a clinic. Which outcome is best for the nurse to document in the client's plan of care? •A. The client will lose 2 lb per week for the next 4 weeks. •B. The client will gain 2 lb per week for the next 4 weeks. •C. Teach the client to increase intake of fruits and vegetables. D. Inform the client to call the clinic weekly with weight results

A. The client will lose 2 lb per week for the next 4 weeks.

An older adult patient who is having an annual check-up tells the nurse, "I feel fine, and I don't want to pay for all these unnecessary cancer screening tests!" Which information should the nurse plan to teach this patient? a. Consequences of aging on cell-mediated immunity b. Decrease in antibody production associated with aging c. Impact of poor nutrition on immune function in older peopled. Incidence of cancer-stimulating infections in older individuals

ANS: AThe primary impact of aging on immune function is on T cells, which are important for immune surveillance and tumor immunity. Antibody function is not affected as much by aging. Poor nutrition can also contribute to decreased immunity, but there is no evidence that it is a contributing factor for this patient. Although some types of cancer are associated with specific infections, this patient does not have an active infection.

The nurse is assigned to care for a client with systemic lupus erythematosus (SLE). The nurse plans care knowing that this disorder is: A local rash that occurs as a result of allergy A disease caused by overexposure to sunlight An inflammatory disease of collagen contained in connective tissue A disease caused by the continuous release of histamine in the body

An inflammatory disease of collagen contained in connective tissue

A nurse is instructing a group of overweight clients on the complications of obesity that develop when weight is not controlled through diet and exercise. Which lifestyle changes does the nurse emphasize? Select all that apply. A. "Begin a weight-training program for building muscle mass." B. "Consume a diet that is moderate in salt and sugar and low in fats and cholesterol." C. "Eat a variety of foods, especially grain products, vegetables, and fruits." D. "Engage in moderate physical activity for at least 30 minutes each day." E. "Foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home." F. "Liquid dietary supplements can be substituted safely for solid food while attempting to lose weight."

Answers B, C, D, E Feedback: Correct: Consuming a diet that is moderate in salt and sugar and low in fats and cholesterol is a smart strategy for a person who wants to lose weight. Correct: Eating a variety of foods, especially grain products, vegetables, and fruits, helps people achieve weight loss. These are foods that "burn" more calories as they are metabolized. Correct: Moderate physical activity for at least 30 minutes each day is a good idea for people who are trying to be healthy and/or to reduce their weight. Correct: True. Many foods eaten away from home tend to be higher in fat, cholesterol, and salt and lower in calcium than foods prepared at home. When dining "out," people can make smart choices, but they have to be educated and careful.

The nurses are discussing feeding tube migration and prevention. Which of the following statements indicates correct understanding?A) As long as the external portion of a feeding tube is taped in place, the tube will be unable to migrate out of position. B) A feeding tube can enter the airway without causing obvious respiratory symptoms. C) The nurse should have the patient deep breathe and cough and suction the patient frequently. D) The nurse should keep the head of the bed flat to reduce the risk of tube migration.

B) A feeding tube can enter the airway without causing obvious respiratory symptoms.

The patient begins to cough and choke as the nurse is inserting the NG tube. What is the best action for the nurse to take at this time? A) Pull the feeding tube out and start over in the opposite naris. B) Pull the tube back and attempt to reinsert. C) Instruct the patient to take small sips of water and swallow. D) Auscultate over the carina.

B) Pull the tube back and attempt to reinsert.

You attempt to aspirate gastric contents from an established NG feeding tube and get zero return. What should you do next? A) Document the finding. B) Reposition the patient. C) Assume that the tube is in the appropriate place and start the tube feeding. D) Get an order for a chest x-ray to verify placement before administering the tube feeding. E) Remove the tube and insert a new one.

B) Reposition the patient.

If the nurse suspects the NG feeding tube has migrated, the nurse should: A) Instill 10 mL of water into the feeding tube, reinsert the stylet, and reposition the tube. B) Stop any enteral feedings and obtain an order for a chest x-ray to determine placement. C) Irrigate the tube with tap water. D) Reposition the patient from side to side

B) Stop any enteral feedings and obtain an order for a chest x-ray to determine placement.

The nurse is inserting an NG feeding tube for the first time. Which action, if made by the nurse, indicates that further instruction is needed? A) The nurse dips the end of the tube into a glass of water. B) The nurse has the patient flex the head as the tube is inserted into the naris. C) The nurse aims back and down toward the ear. D) The nurse advances the tube as the patient swallows.

B) The nurse has the patient flex the head as the tube is inserted into the naris.

Which of the following is NOT an appropriate technique for administering enteral formulas? A) Continuous feeding pump B) Through a large vein C) Intermittent gravity drip D) Large-bore syringe (bolus)

B) Through a large vein

A malnourished client is being discharged on enteral nutrition products. Which suggestion from the registered dietitian does the nurse implement to make the enteral feeding experience more normal for the client? A. Administering the feeding product on a regular schedule B. Bringing the enteral product and napkin to the client on a tray C. Emphasizing the need to take iron medications before the feeding D. Once feeding is completed, putting equipment out of view

B. Bringing the enteral product and napkin to the client on a tray Rationales: Incorrect: Although the feeding product should be administered according to the prescribed schedule, this will not necessarily normalize the experience for the client. Correct: "Serving" the enteral product and napkin on a tray will help normalize the feeding experience for the client. Incorrect: Although iron medications may be helpful in preventing constipation, encouraging their use will not normalize the experience for the client. Incorrect: Although putting equipment away after use may be helpful in taking the client out of the dependent "client" role, this will not serve to normalize the feeding experience itself.

A client is receiving nutritional supplements to restore nutritional status. What does the nurse do to assess the effectiveness of the supplements for the client? A. Keeps an accurate and precise food and fluid intake record daily B. Makes certain the client is weighed daily at the same time C. Monitors vital signs every 4 hours and as needed D. Weekly assesses the client's skin for evidence(s) of breakdown

B. Makes certain the client is weighed daily at the same time

Which adult will the nurse plan to teach about risks associated with obesity? a. Man who has a BMI of 18 kg/m2 b. Man with a 42 in waist and 44 in hips c. Woman who has a body mass index (BMI) of 24 kg/m2 d. Woman with a waist circumference of 34 inches (86 cm)

B. Obese waist Circumference:Men: >40inFemale: >35in

The client's infusion pump delivering TPN malfunctions. The nurse determines that, based on the amount still in the bag, the client did not receive any TPN for the last 6 hours. The nurse should monitor the client for which immediate complication? •A. Air embolism •B. Rebound hypoglycemia •C. Rebound hyperglycemia •D. Low serum albumin level

B. Rebound hypoglycemia •Because the TPN solution is high in dextrose, rebound hypoglycemia can occur from the delayed pancreatic reaction to a change in insulin requirements.

The client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? A. Administering intravenous (IV) pain medication B. Starting a large-bore intravenous (IV) C. Monitoring the client's anxiety level D. Preparing equipment for intubation

B. Starting a large-bore intravenous (IV)

The teaching plan for the patient being discharged following an acute episode of upper GI bleeding will concern information concerning the importance of (select all that apply) a. only taking aspirin with milk or bread products b. avoiding taking aspirin and drugs containing aspirin c. taking only drugs prescribed by the health care provider d. taking all drugs 1 hour before mealtime to prevent further bleeding e. reading all OTC drug labels to avoid those containing stearic acid and calcium

B. avoiding taking aspirin and drugs containing aspirin C. taking only drugs prescribed by the healthcare provider

A patient seen in the outpatient clinic has an immune deficiency involving the Tlymphocytes.The nurse should teach the patient about the need for more frequent screening fora. allergies.b. malignancy.c. antibody deficiency.d. autoimmune disorders.

BCell-mediated immunity is responsible for the recognition and destruction of cancer cells.Allergic reactions, autoimmune disorders, and antibody deficiencies are mediatedprimarily by humoral immunity.

You are to irrigate the patient's established feeding tube with 30 mL of tap water before instilling the tube feeding. Upon attempting to do so, you find that you are unable to instill the fluid. What should your next action be? A) Notify the physician. B) Irrigate the tubing with soda, such as Coca-Cola. C) Reposition the patient. D) Use a smaller-sized syringe with the plunger to push the fluid through the feeding tube.

C) Reposition the patient.

Which of the following medications should never be given through a feeding tube? (Select all that apply.) A) Liquid medications B) Elixirs C) Sublingual tablets D) Enteric-coated (EC) E) Sustained release (SR) F) Extended release (XR) G) Long acting (LA) H) Large tablets or pills

C) Sublingual tablets D) Enteric-coated (EC) E) Sustained release (SR) F) Extended release (XR) G) Long acting (LA)

A patient is receiving a continuous enteral feeding by infusion pump. You enter the patient's room to verify tube placement and measure residual. You notice that the patient's respirations are shallow and rapid and that the patient's color is ashen. You find rhonchi upon auscultation, and the patient appears to be coughing up sputum of a color similar to the formula feeding. What action(s) should you take? (Select all that apply.) A) Ask the patient if she feels short of breath .B) Administer oxygen. C) Turn off the tube feeding. D) Have the patient deep breathe and cough. E) Position the patient in Fowler's position and suction the patient. F) Position patient on the left side and suction the patient. G) Notify the physician. H) Prepare for chest x-ray examination.

C,E,G,H

A nurse is performing a health assessment on an obese client. The client states, "I have tried many diets in an effort to lose weight but have been unsuccessful!" How does the nurse assess whether the client's response to stress is related to the client's obesity? A. "Do you have a history of mental problems, especially depression?" B. "Do you usually use alcohol or drugs when you feel stressed?" C. "Tell me what you do to relieve stress in your daily life." D. "What is it about your obesity that causes you to feel uncomfortable?"

C. "Tell me what you do to relieve stress in your daily life."

Nurse Spencer is caring for an anorexic client who is having total parenteral nutrition solution for the first time. Which of the following assessments requires the most immediate attention? A. Dry sticky mouth. B. Temperature of 100° Fahrenheit. C. Blood glucose of 210 mg/dl. D. Fasting blood sugar of 98 mg/dl

C. Blood glucose of 210 mg/dl.

The nurse is caring for a patient who encountered a minor esophageal injury after accidently swallowing a piece of a chicken bone. The patient will receive medications and nutrition for 4 to 6 days by nasogastric tube to control mucosal damage and promote healing. Which of the following actions should the nurse plan to take first when administering medications through the nasogastric tube? A. Verify the patient's identification and explain the procedure to the patient. B. Flush the nasogastric tube with 30 to 50 mL per hospital policy prior to administering the medication. C. Check the provider's order. D. Prepare the medication for administration.

C. Check the provider's order. The nurse always checks the physician's order before administering a medication. After verification of the order, the RN determines that the medication is appropriate to be given though a nasogastric tube. Certain medications have a delayed action or enteric coating. Check the approved drug reference or agency pharmacy to verify that these medications can be given through a nasogastric tube. If a medication is not available in an elixir form, the nurse prepares the medication by crushing pills or opening capsules and mixing each medication in 15 to 30 ml of water. Confirmation of patient identification, tube placement, residual volume, and presence of bowel sounds are checked. Medication is drawn up with the appropriate catheter-tip syringe and administered to the patient and then flushed with 15 to 30 ml of water. Documentation of medication administration and any pertinent information is completed.

A client receiving total parenteral nutrition (TPN) exhibits symptoms of congestive heart failure (CHF) and pulmonary edema. Which complication of TPN is the client most likely experiencing? A. Calcium imbalance B. Fluid volume deficit C. Fluid volume overload D. Potassium imbalance

C. Fluid volume overload

The client with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? "1. Development of laryngeal cancer.2. Irritation of the esophagus. 3. Esophageal scar tissue formation. 4. Aspiration of gastric contents

Clients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents.

A key part of the nursing process when caring for a client who is receiving immunosuppressant therapy should be to 1. assess nutritional status. 2. monitor vital signs. 3. assess renal function .4. monitor liver function studies.

Correct Answer: 3 Rationale: Renal function is key because these drugs can cause nephrotoxicity because of physiological changes in the kidneys.

A client is receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse next assesses the client to identify the presence of which of the following? Hypotension. Crackles upon auscultation of the lungs. Thirst. Polyuria

Crackles upon auscultation of the lungs. Normally, the weight gain of a client receiving PN is about 1-2 pound a week. A weight gain of five (5) pounds over a week indicates a client is experiencing fluid retention that can result to hypervolemia. Signs of hypervolemia includes weight gain more than desired, headache, jugular vein distention, bounding pulse, and crackles on lung auscultation

What is the difference between a PEG tube and a gastrostomy tube? A) A PEG tube is inserted into the jejunum; a gastrostomy tube is located in the stomach. B) A PEG tube exits from the right upper quadrant and a gastrostomy tube exits from the upper left quadrant. C) A PEG tube is inserted through the abdominal wall and a gastrostomy tube is inserted through the nose. D) A PEG tube is inserted by using endoscopic visualization of the stomach and is held in place by its design; a gastrostomy tube is inserted surgically and is held in place by sutures.

D) A PEG tube is inserted by using endoscopic visualization of the stomach and is held in place by its design; a gastrostomy tube is inserted surgically and is held in place by sutures.

Which of the following accurately describes the greatest risk related to having a feeding tube? A) Electrolyte imbalance B) Fluid volume overload C) Infection D) Aspiration

D) Aspiration

The nurse is going to administer a bolus enteral tube feeding of 240 mL. The nurse has obtained a pH of 4 and 50 mL of gastric aspirate. Based on these findings, what action should the nurse take? A) Stop the feeding and recheck the residual in one hour. B) Reposition the feeding tube under fluoroscopy. C) Discard the aspirate and continue with the bolus feeding as prescribed. D) Return the aspirate to the patient's stomach and administer the feeding.

D) Return the aspirate to the patient's stomach and administer the feeding.

The nurse completed teaching for the client who will be receiving TPN while at home. Which client statement indicates that further teaching is needed? •A. "My refrigerator is big enough to store several bags of parenteral solution." •B. "I will keep my cellular phone with me at all times to use in an emergency." •C. "I plan to use the main floor bedroom; it'll be best with the infusion pump." •D. "I'll sit at the table to remove the IV catheter cap to attach the IV tubing."

D. "I'll sit at the table to remove the IV catheter cap to attach the IV tubing." . The IV infusion tubing is connected to the insertion site cap and not removed to administer the TPN solution. Caps are changed every 3 to 7 days during dressing changes, with the client in a flat position. An air embolus can occur if the cap is removed while the client is in a sitting position. (Some hospital policies say to change caps daily when hanging a new bag of TPN)

Which client on a medical-surgical unit does the charge nurse assign to the LPN/LVN? A. 28-year-old with morbid obesity who had bariatric surgery today B. 30-year-old recently admitted with severe diarrhea and Clostridium difficile infection C. 36-year-old whose family needs instruction about how to use a gastric feeding tube D. 39-year-old with a jejunal feeding tube who needs elemental feedings administered

D. 39-year-old with a jejunal feeding tube who needs elemental feedings administered

An RN receives the change-of-shift report about these clients. Which client does the nurse assess first? A. 30-year-old admitted 2 hours ago with malnutrition that is associated with malabsorption syndrome B. 45-year-old who had gastric bypass surgery and is reporting severe incisional pain C. 50-year-old receiving total parenteral nutrition (TPN) with a blood glucose (BG) level of 300 mg/dL D. 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min

D. 75-year-old with dementia who is receiving nasogastric feedings and has a respiratory rate of 38 breaths/min Rationales: Incorrect: The client admitted 2 hours ago with malnutrition needs assessments and/or interventions by the RN, but maintaining respiratory function in the client with tachypnea is the highest priority. Incorrect: The client who had gastric bypass surgery and is reporting severe incisional pain needs assessments and/or interventions by the RN, but maintaining respiratory function in the client with tachypnea is the highest priority. Incorrect: The client receiving TPN with a BG level of 300 mg/dL needs assessments and/or interventions by the RN, but maintaining respiratory function in the client with tachypnea is the highest priority. Correct: Aspiration is a major complication in clients receiving tube feedings, especially in clients with an altered level of consciousness. This client needs respiratory assessment and interventions immediately.

Which assessment data support to the the nurse the client's diagnosis of gastric ulcer? A. Presence of blood in the client's stool for the past month? B. Reports of a burning sensation moving like a wave. C. Sharp pain in the upper abdomen after eating a heavy meal. D. Complaints of epigastric pain 30-60 minutes after ingesting food

D. Complaints of epigastric pain 30-60 minutes after ingesting food In a client diagnosed with a gastric ulcer, pain usually occurs 30-60 minutes after eating, but not at night. In contrast, a client with a duodenal ulcer has pain during the night often relieved by eating food

A patient has begun immunotherapy for the treatment of intractable environmental allergies. When administering the patient's immunotherapy, which of the following is the nurse's priority action?A. Monitoring the patient's fluid balance B. Assessing the patient's need for analgesia C. Assessing the patient for changes in level of consciousness D. Monitoring for signs and symptoms of an adverse reaction

D. Monitoring for signs and symptoms of an adverse reaction

A client is discharged home with an enteral feeding tube. What does the home health nurse do to determine the patency of the client's enteral tube? A. Arranges for the client to have an x-ray performed periodically B. Auscultates the client's abdomen for bowel sounds before each feeding C. Instills air into the tube to check for placement and patency before each feeding D. Tests aspirated tube contents for pH level before each feeding

D. Tests aspirated tube contents for pH level before each feeding

A nurse working in an endoscopy clinic is screening patients for the risk of developing Barrett's esophagus. The nurse should consider which patient at greatest risk? A. The patient with a 20-year history of alcohol abuse B. The patient with a 30-pack-per-year smoking history C. The patient who ingested lye as a child and is now 47 years old D. The patient who has had untreated GERD for 30 years

D. The patient who has had untreated GERD for 30 years The patient with untreated GERD is at greatest risk. Barrett's esophagus is found in the lower one third of the esophagus, mainly at the gastroesophageal junction (GEJ) and cardiac (first part of the stomach) of the stomach. Long-term exposure to gastric acid reflux causes metaplastic transformation (Barrett's esophagus) that leads to esophageal adenocarcinoma. Alcohol abuse,cigarette smoking, and lye ingestion are risk factors of squamous cell carcinoma of the upper portions of the esophagus.

A client who is receiving total enteral nutrition (TEN) exhibits acute confusion and shallow breathing and says, "I feel weak." As the client begins to have a generalized seizure, how does the nurse interpret this client's signs and symptoms? A. The enteral tube is misplaced or dislodged. B. Abdominal distention is present. C. A fluid and electrolyte imbalance is present. D. This is refeeding syndrome.

D. This is refeeding syndrome. Incorrect: If the enteral tube becomes misplaced or dislodged, the client may develop aspiration pneumonia displayed by increased temperature, increased pulse, dehydration, diminished breath sounds, and shortness of breath. Incorrect: Abdominal distention is most frequently accompanied by nausea and vomiting.Incorrect: Signs and symptoms of fluid and electrolyte problems resulting in circulatory overload can include peripheral edema, sudden weight gain, crackles, dyspnea, increased blood pressure, and bounding pulse. Correct: Symptoms of refeeding syndrome include shallow respirations, weakness, acute confusion, seizures, and increased bleeding tendency.

The nurse explains to the patient with gastroesophageal reflux disease that this disorder: A. results in acid erosion and ulceration of the esophagus caused by frequent vomiting B. will require surgical wrapping or repair of the pyloric sphincter to control the symptoms C. is the protrusion of a portion of the stomach into to esophagus through an opening in the diaphragm D. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus

D. often involves relaxation of the lower esophageal sphincter, allowing stomach contents to back up into the esophagus

A client is being weaned off from parenteral nutrition (PN) and is given a go-signal to take a regular diet. The ongoing solution rate has been 120ml/hr. A nurse expects that which of the following prescriptions regarding the PN solution will accompany the diet order? Decrease the PN rate to 60ml/hr. Start 0.9% normal saline at 30 ml/hr. Maintain the present infusion rate. Discontinue the PN.

Decrease the PN rate to 60ml/hr.

Which of the following occurs to blood vessels during an anaphylactic reaction?Constriction No change Spasm Dilation

Dilation

The client prescribed a high-protein, high-calorie diet is not meeting protein or caloric intake goals. The client states, "I feel full quickly after eating three meals daily." Which interventions should the nurse recommend? Select all that apply. •A. Include more fresh fruits and vegetables in the diet. •B. Eat six smaller meals instead of three meals daily. •C. Include protein bars and whole milk yogurt as snacks. •D. Drink regular instead of diet carbonated beverages. •E. Add protein supplements to cooked cereals.

Eat six smaller meals instead of three meals daily. Include protein bars and whole milk yogurt as snacks. Add protein supplements to cooked cereals.

Which diagnostic test would be used first to evaluate a client with upper GI bleeding? Endoscopy Upper GI series Hemoglobin (Hb) levels and hematocrit (HCT Arteriography

Hemoglobin (Hb) levels and hematocrit (HCT Hemoglobin and hematocrit are typically performed first in clients with upper GI bleeding to evaluate the extent of blood loss. Endoscopy is then performed to directly visualize the upper GI tract and locate the source of bleeding.

A nurse is preparing to hang the initial bag of the parenteral nutrition (PN) solution via the central line of a malnourished client. The nurse ensure the availability of which medical equipment before hanging the solution? Glucometer. B Dressing tray. C Nebulizer. Infusion pump

Infusion pump

A client receiving parenteral nutrition (PN) complains of shortness of breath and shoulder pain. A nurse notes that the client has an increased pulse rate. The nurse determines that the client is experiencing which complication of PN therapy? Air embolism. Hypervolemia. Hyperglycemia. Pneumothorax.

Pneumothorax.

A client is receiving parenteral nutrition (PN) suddenly is having a fever. A nurse notifies the physician and the physician initially prescribes that the solution and tubing be changed. The nurse should do which of the following with the discontinued materials? Send them to the laboratory for culture. Save them for a return to the manufacturer. Return them to the hospital pharmacy. Discard them in the unit trash.

Send them to the laboratory for culture.

A nurse is preparing to hang a fat emulsion (lipids) and observes some visible fat globules at the top of the solution. The nurse ensure to do which of the following actions? Take another bottle of solution. Runs the bottle solution under a warm water. Rolls the bottle solution gently. Shake the bottle solution vigorously.

Take another bottle of solution.

A nurse has educated a client on an epinephrine auto-injector (EpiPen). What statement by the client indicates additional instruction is needed? a. "I don't need to go to the hospital after using it." b. "I must carry two EpiPens with me at all times." c. "I will write the expiration date on my calendar." d. "This can be injected right through my clothes."

a. "I don't need to go to the hospital after using it."

Which patient statement indicates that the nurse's teaching following a gastroduodenostomy has been effective? a. "Vitamin supplements may prevent anemia." b. "Persistent heartburn is common after surgery." c. "I will try to drink more liquids with my meals." d. "I will need to choose high carbohydrate foods."

a. "Vitamin supplements may prevent anemia."

A patient who has received allergen testing using the cutaneous scratch method has developed itching and swelling at the skin site. Which action should the nurse take first? a. Administer epinephrine. b. Apply topical hydrocortisone. c. Monitor the patient for lower extremity edema. d. Ask the patient about exposure to any new lotions or soaps.

a. Administer epinephrine.

What foods should a patient with a history of a hiatal hernia avoid? Select all that apply a. Alcohol b. Carbonated beverages c. Citrus foods or drinks d. High fiber foods e. Tomatoes

a. Alcohol b. Carbonated beverages c. Citrus foods or drinks e. Tomatoes

When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include? a. Blood glucose test b. Cardiac enzyme tests c. Postural blood pressures d. Resting electrocardiogram

a. Blood glucose test

The nurse will be teaching self-management to patients after gastric bypass surgery. Which information will the nurse plan to include? a. Drink fluids between meals but not with meals. b. Choose high-fat foods for at least 30% of intake .c. Developing flabby skin can be prevented by exercise. d. Choose foods high in fiber to promote bowel function.

a. Drink fluids between meals but not with meals.

The physician just left the patient's room after explaining the options of NG or NI feeding tube placement. A student asks a nurse about the differences between nasogastric and nasointestinal feedings. Which of the following are accurate statements made by the nurse? (Select all that apply.) A) Insertion of an NG tube requires clean gloves, whereas insertion of an NI tube requires sterile gloves. B) It would be unexpected for there to be more than 10 mL of gastric aspirate obtained from an NI tube or more than 200 mL from an NG tube. C) The advantage to an NI tube is that there is less risk for aspiration .D) NI tubes are used for patients with nasal problems such as nosebleeds or deviated septums. NG tubes are used for patients without nasal problems. E) Both NG and NI tubes are usually used for less than 30 days.

b,c,e

Which diagnostic results support the diagnosis of peptic ulcer disease (PUD)? (Select all that apply.)a. Low hemoglobin (Hgb)b. Low white blood cell (WBC) levelc. Low hematocrit (Hct)d. Positive for H. pylori bacteriae. Low potassium of 3.4 mEq/L

a. Low hemoglobin (Hgb)c. Low hematocrit (Hct)d. Positive for H. pylori bacteria

For early detection of an anaphylactic reaction in a patient who has received allergen testing using the cutaneous scratch method, which action should the nurse take first?a. Check blood pressure and pulse rate.b. Auscultate the lung sounds bilaterally.c. Monitor pupil size and reaction to light.d. Assess the arm at the site of the skin testing.

d. Assess the arm at the site of the skin testing.

The leukocyte that will be elevated in a viral infection are: a. lymphocytes b. monocytes c. neutrophils d. macrophages

a. lymphocytes

What type of bleeding will a pt with peptic ulcer disease with a slow upper GI source of bleeding have? a. melena b. occult blood c. coffee-ground emesis d. profuse bright-red hematemesis

a. melena -melena is black, tarry stools from slow bleeding from an upper GI source when blood passes through the GI tract and is digested

The reason newborns are protected for the first 6 months of life from bacterial infections is because of the maternal transmission of a.IgG .b.IgA. c.IgM. d.IgE.

a.IgG

The most common cause of secondary immunodeficiencies is a.drugs. b.stress. c.malnutrition. d.human immunodeficiency virus.

a.drugs.

The nurse is alerted to possible anaphylactic shock immediately after a patient has received intramuscular penicillin by the development of a.edema and itching at the injection site. b.sneezing and itching of the nose and eyes .c.a wheal-and-flare reaction at the injection site. d.chest tightness and production of thick sputum.

a.edema and itching at the injection site.

a nurse is admitting a client who has anorexia. which lab is expected to be altered? creatine kinase troponin total bilirubin albumin

albumin

foods to avoid in GERD/hiatal hernia

alcohol, chocolate, caffeine, fatty foods, peppermint, acidic foods

important things regarding contrast

allergies kidney function make sure metformin in held 48 hr before and after make sure patient has bowel movement (bowel might be pale-white)

What increases a patient's risk for candidiasis?

antibiotics and corticosteroids

After bariatric surgery, a patient who is being discharged tells the nurse, "I prefer to be independent. I am not interested in any support groups." Which response by the nurse is best? a. "I hope you change your mind so that I can suggest a group for you." b. "Tell me what types of resources you think you might use after this surgery." c. "Support groups have been found to lead to more successful weight loss after surgery." d. "Because there are many lifestyle changes after surgery, we recommend support groups."

b. "Tell me what types of resources you think you might use after this surgery."

Which statement by the nurse is most likely to help a morbidly obese 22-year-old man in losing weight on a 1000-calorie diet? a. "It will be necessary to change lifestyle habits permanently to maintain weight loss." b. "You will decrease your risk for future health problems such as diabetes by losing weight now." c. "You are likely to notice changes in how you feel with just a few weeks of diet and exercise." d. "Most of the weight that you lose during the first weeks of dieting is water weight rather than fat."

b. "You will decrease your risk for future health problems such as diabetes by losing weight now."

Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program? a. Having the adults write down the caloric intake of each meal b. Asking the adults about situations that tend to increase appetite c. Suggesting that the adults plan rewards, such as sugarless candy, for achieving their goals d. Encouraging the adults to eat small amounts frequently rather than having scheduled meals

b. Asking the adults about situations that tend to increase appetite

Which assessment action will help the nurse determine if an obese patient has metabolic syndrome?a. Take the patient's apical pulse. b. Check the patient's blood pressure c. Ask the patient about dietary intake. d. Dipstick the patient's urine for protein.

b. Check the patient's blood pressure

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? a. Barium swallow b. Endoscopic biopsy c. Capsule endoscopy d. Endoscopic ultrasonography

b. Endoscopic biopsy(Because of this patient's history of excessive alcohol intake, smoking, and hemoptysis and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well.)

What are complications of Peptic Ulcer Disease? Select all that apply. a. Cough b. Hemmorhage c. Perforation d. Pneumonia e. Obstruction

b. Hemmorhage c. Perforation e. Obstruction

Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en-Y gastric bypass? a. Educating the patient about the nasogastric (NG) tube b. Instructing the patient on coughing and breathing techniques c. Discussing necessary postoperative modifications in lifestyled. d. Demonstrating passive range-of-motion exercises for the legs

b. Instructing the patient on coughing and breathing techniques

Why is the inflammatory response alone insufficient to provide complete protection against infection? a. It only responds to tissue injury and not to invasion by microorganisms. b. It is nonspecific and no long-lasting immunity is generated by inflammation alone. c. When the inflammatory response is prolonged, it can cause serious tissue damage. d. The body is not capable of synthesizing antibodies at the same time that inflammatory processes are active. e. None of above

b. It is nonspecific and no long-lasting immunity is generated by inflammation alone. The cells that provide the protection of inflammation, the neutrophils and the macrophages, have no "memory" to aid them in mounting a faster or stronger response to an invading microorganism upon repeated or subsequent exposure. Without antibody-mediated immunity and cell-mediated immunity to augment the inflammatory response, humans remain susceptible to reinfection by the same microorganism over and over again.

Which of the following describes proper patient teaching for a patient with chronic gastritis? Select an answer and submit. For keyboard navigation, use the up/down arrow keys to select an answer. a. Eliminate alcohol & caffeine from the diet when symptoms occur. b. Maintain a nonirritating diet with six small meals a day. c. Take antacids before meals to decrease stomach acidity. d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of aspirin for pain relief.

b. Maintain a nonirritating diet with six small meals a day.

When caring for a patient in the initial postoperative period after a partial glossectomy with a radial neck dissection, which of the following is the nurse's primary concern? Select an answer and submit. For keyboard navigation, use the up/down arrow keys to select an answer. a. Assessing the patient's coping. b. Maintaining a patent airway. c. Providing adequate nutrition d. Relieving the patient's pain.

b. Maintaining a patent airway.

The nurse teaches a patient diagnosed with systemic lupus erythematosus (SLE) about plasmapheresis. What instructions about plasmapheresis should the nurse include in the teaching plan? a. Plasmapheresis will eliminate eosinophils and basophils from blood. b. Plasmapheresis will remove antibody-antigen complexes from circulation. c. Plasmapheresis will prevent foreign antibodies from damaging various body tissues. d. Plasmapheresis will decrease the damage to organs caused by attacking T lymphocytes.

b. Plasmapheresis will remove antibody-antigen complexes from circulation.

Which of the following statements made by the nurse is most appropriate in teaching patient interventions to minimize the effects of seasonal allergic rhinitis?A. "You will need to get rid of your pets."B. "You should sleep in an air-conditioned room."C. "You would do best to stay indoors during the winter months."D. "You will need to dust your house with a dry feather duster twice a week."

b. Seasonal allergic rhinitis is most commonly caused by pollens from trees, weeds, and grasses. Airborne allergies can be controlled by sleeping in an air-conditioned room, daily damp dusting, covering the mattress and pillows with hypoallergenic covers, and wearing a mask outdoors.

You are caring for a patient who has a severe rash and itching from poison ivy in the lower legs. This reaction is best understood as an example of cell mediated immunity. The cell type involved in this type of immunity are: a. B lymphocytes b. T lymphocytes c. Natural killer cells d. Antibodies

b. T lymphocytes

A patient's low hemoglobin and hematocrit have necessitated a transfusion of packed red blood cells (PRBCs). Shortly after the first unit of PRBCs is hung, the patient develops signs and symptoms of a transfusion reaction. Which of the following hypersensitivity reactions has the patient experienced? A. Type I B. Type II C. Type III D. Type IV

b. Transfusion reactions are characterized as a type II (cytotoxic) reaction in which agglutination and cytolysis occur.

The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Vitamin E

b. Vitamin B12 Chronic gastritis causes deterioration and atrophy of the lining of the stomach, leading to the loss of the function of the parietal cells. The source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia.

when do we flush tube feedings?

before AND after feedings and medication administration

A patient with a history of PUD is hospitalized with symptoms of a perforation. During the initial assessment, the nurse expects the patient to report which of the following signs and symptoms? Select an answer and submit. For keyboard navigation, use the up/down arrow keys to select an answer. a Hyperactive bowel sounds and upper abdominal swelling b Projectile vomiting of undigested foods c Sudden, severe upper abdominal pain and back pain d Vomiting of bright red blood

c Sudden, severe upper abdominal pain and back pain

The nurse is caring for a 54-year-old female patient on the first postoperative day after a Roux-en-Y gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon? a. Bilateral crackles audible at both lung bases b. Redness, irritation, and skin breakdown in skinfolds c. Emesis of bile-colored fluid past the nasogastric (NG) tubed. d. Use of patient-controlled analgesia (PCA) several times an hour for pain

c. Emesis of bile-colored fluid past the nasogastric (NG) tubed

Which of the following is the most common sign of GERD? Select an answer and submit. For keyboard navigation, use the up/down arrow keys to select an answer. a. Aphagia b. Cough c. Heartburn d, Itching throat

c. Heartburn

A patient has been admitted to the hospital due to experiencing vomiting for several days. The cause of the patient's vomiting is unknown. Which of the following interventions should be considered the nurse's priority in providing care for this patient? a. Administration of parental antiemetics. b. Insertion of an NG tube for suction. c. IV replacement of fluid and electrolytes. d. Oral administration of broth & tea.

c. IV replacement of fluid and electrolytes. d

A patient is admitted to the ER with bright red emesis. What is the nurse's initial care of this patient? Select an answer and submit. For keyboard navigation, use the up/down arrow keys to select an answer. a. Establish two IV sites with large gauge catheters b. Obtain a thorough health history to assist in determining the cause of the bleeding c. Provide a focused nursing assessment of the patient's status d. Provide a gastric lavage with cool tap water in preparation for an endoscopic procedure

c. Provide a focused nursing assessment of the patient's status

Which manifestations or processes of inflammation are caused specifically by blood vessel dilation? a. Increased production and migration of leukocytes b. Phagocytosis and fever c. Warmth and redness d. Swelling and paine. None of above

c. Warmth and redness

At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. The nurse will teach the patient to a. increase the amount of fluid with meals. b. eat foods that are higher in carbohydrates. c. lie down for about 30 minutes after eating. d. drink sugared fluids or eat candy after meals.

c. lie down for about 30 minutes after eating. The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating.

The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? a. regular diet b. skim milk c. nothing by mouth d. clear liquids

c. nothing by mouth

TPN risks

infection (bacterial or fungal) air emboli wrong spot electrolyte imbalances hyper/hypoglycemia

A nurse is completing an assessment of a pt who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply) a. pt reports pain relieved by eating b. pt states pain often occurs at night c. pt reports a sensation of bloating d. pt states that pain occurs 30 min - 1 hr after a meale. pt experiences pain upon palpation of the epigastric region

c. pt reports a sensation of bloating d. pt states that pain occurs 30 min - 1 hr after a meal e. pt experiences pain upon palpation of the epigastric region

A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in her treatment to a.remove T lymphocytes in her blood that are producing antinuclear antibodies. b.remove normal particles in her blood that are being damaged by autoantibodies. c.exchange her plasma that contains antinuclear antibodies with a substitute fluid. d.replace viral-damaged cellular components of her blood with replacement whole blood.

c.exchange her plasma that contains antinuclear antibodies with a substitute fluid.

One function of cell-mediated immunity is a.formation of antibodies. b.activation of the complement system. c.surveillance for malignant cell changes. d.opsonization of antigens to allow phagocytosis by neutrophils.

c.surveillance for malignant cell changes.

right lower quadrant contains

cecum, appendix, right ovary and tube, right ureter, right spermatic cord

cell-mediated immunity vs humoral

cell mediated: type of immunity produced by T cells that attack infected or abnormal body cells humoral: specific immunity produced by B cells that produce antibodies that circulate in body fluids

its been 24 hours and there is still food in TPN; what do you do?

change it

left lower quadrant contains

colon, small intestine, ureter, major vein and artery to left leg

A nurse receives in report that a male patient who had Billroth II procedure a few weeks ago is now experiencing dumping syndrome. Which of the following statements most accurately explains the pathophysiology associated with the patient's symptoms. a Distention of the stomach due to too much food and fluid intake b Hyperglycemia caused by uncontrolled gastric emptying into the small intestines c Irritation of the stomach lining by reflux of bile salts because of the removal of the pyloric sphincter d Movement of fluid into the small bowel because food and fluids move rapidly into the intestines.

d Movement of fluid into the small bowel because food and fluids move rapidly into the intestines.

The nurse is caring for a patient undergoing plasmapheresis. The nurse should assess the patient for which clinical manifestation? a. Shortness of breath b. High blood pressure c. Transfusion reaction d. Numbness and tingling

d. Numbness and tingling

After vertical banded gastroplasty, a 42-year-old male patient returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the postoperative plan of care? a. Offer sips of fruit juices at frequent intervals. b. Irrigate the nasogastric (NG) tube frequently. c. Remind the patient that PCA use may slow the return of bowel function. d. Support the surgical incision during patient coughing and turning in bed

d. Support the surgical incision during patient coughing and turning in bed

Which assessment should the nurse perform first for a patient who just vomited bright red blood?a. Measuring the quantity of emesisb. Palpating the abdomen for distentionc. Auscultating the chest for breath soundsd. Taking the blood pressure (BP) and pulse

d. Taking the blood pressure (BP) and pulse assess for shock!!

The function of monocytes in immunity is related to their ability to a.stimulate the production of T and B lymphocytes. b.produce antibodies on exposure to foreign substances. c.bind antigens and stimulate natural killer cell activation. d.capture antigens by phagocytosis and present them to lymphocytes.

d.capture antigens by phagocytosis and present them to lymphocytes.

In a type I hypersensitivity reaction the primary immunologic disorder appears to be a.binding of IgG to an antigen on a cell surface. b.deposit of antigen-antibody complexes in small vessels. c.release of cytokines used to interact with specific antigens. d.release of chemical mediators from IgE-bound mast cells and basophils.

d.release of chemical mediators from IgE-bound mast cells and basophils.

Antibody mediated immunity (Humeral immunity) complements the inflammatory response because: a. It is specific and has the ability to recognize previous antigens b. Is quick acting, responding to a recognized antigen within 6 hours c. Is delayed in its response to a recognized antigen, taking 1-3 days d. a&b e. a&c

e. a&c

nurse is teaching a patient with GERD what should she include

eat 4-6 small meals each day bcuz large meals put too much pressure on the stomach client should wait at least 3 hours after eating to go to bed sleep with HOB elevated

who is at highest risk for re-feeding syndrome

elderly malnourished

Re-feeding syndrome: four things to look out for

fluid overload, hypomagnesium, hypophosphotemia, hypokalemia

check residuals in which tube?

g-tube

enteral nutrition

giving nutrients into the gastro-intestinal tract through a feeding tube

parenteral nutrition

giving nutrients through a catheter inserted into a vein

pH in metabolic alkalosis

greater than 7.45

what is a priority finding in a patient with peptic ulcer disease

hematemesis (indicative of massive bleeding)

TPN runs out and next bag isnt ready; what do you do?

hypoglycemia!! start D10!!

A patient is being evaluated for possible atopic dermatitis. The nurse will review the patient's laboratory values for the level of ______________

igE

a nurse is providing discharge teaching to a client who will be receiving TPN at home. which of the following should the nurse include? keep TPN in the fridge when not in use infuse 10% dextrose and water if the solution runs out shake TPN bag with fat emulsion if precipitate is present stop using tpn once weight is normal maintain tpn rate when behind schedule

keep TPN in the fridge when not in use infuse 10% dextrose and water if the solution runs out (this maintains blood glucose levels and prevents hypoglycemia) maintain tpn rate when behind schedule

right upper quadrant contains

liver, stomach, gallbladder, duodenum, right kidney, pancreas

upper endoscopy

make sure to get consent because patient gets anesthesia NPO for 24 hours expect absent gag reflex and sore throat monitor for fever which means perforated bowel. tell provider about this.

a nurse is caring for a client who is receiving tpn via a PICC line. the nurse notes swelling above insertion site. what should she do next?

measure circumference of both arms and if it swollen she should then notify provider.

MRI questions

metal implants?

which mouth concern can result from chemotherapy, renal disease or liver disease?

mucositis

parenteral nutrition cautions

pancreatitis,liver/renal.

Most important question before an x-ray

pregnant?

what to do if residual is too much?

put it back, hold the next feeding, tell the provider

Appendicitis location

right lower quadrant

the nurse should tell a patient with GERD to sleep on what side to minimize effects of reflux during sleep

right side

which of the following is high source of protein? soybeans legumes veggies crackers

soybeans

what to do if residual is more than 250 two times?

start promotility meds (reglan)

left upper quadrant contains

stomach, spleen, left kidney, pancreas

a nurse is planning care for a client who is to start receiving tpn. which intervention should be added? use a 1.2 micron filter when infusing tpn with fat emulsions added allow 18h for lipids to infuse change tpn after 36h change tubing after 48h

use a 1.2 micron filter when infusing tpn with fat emulsions added (this filters out any precipitate that is too large to pass through filter)

how to check if TPN is in the right place

x-ray!!!!