Med Surg 2 chap 39,40,41
A 58-yr-old woman who was recently diagnosed with esophageal cancer tells the nurse, "I do not feel ready to die yet." Which response by the nurse is most appropriate?
"Having this new diagnosis must be very hard for you."
Which finding for a young adult who follows a vegan diet may indicate the need for cobalamin supplementation?
Paresthesias
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates that additional teaching about GERD is needed?
"I eat small meals during the day and have a bedtime snack."
Which statement to the nurse from a patient with jaundice indicates a need for teaching?
"I use acetaminophen (Tylenol) every 4 hours for back pain."
Which information will the nurse include for a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
"Keep the head of your bed elevated on blocks."
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of ranitidine (Zantac)?
"Ranitidine decreases gastric acid secretion."
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?
"Tell me what types of resources you think you might use after this surgery."
The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states
"The cobalamin injections will prevent me from becoming anemic."
Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective?
"Vitamin supplements may prevent anemia."
A 40-yr-old obese woman reports that she wants to lose weight. Which question should the nurse ask first?
"What factors led to your obesity?"
Which statement by the nurse is most likely to help a 22-yr-old patient with extreme obesity in losing weight on a 1000-calorie diet?
"You are likely to notice changes in how you feel after a few weeks of diet and exercise."
After the nurse teaches a patient about the recommended amounts of foods from animal and plant sources, which menu selections indicate that the initial instructions about diet have been understood?
3 oz of roasted pork, a cup of corn, and a cup of carrot sticks
A healthy adult woman who weighs 145 lb (66 kg) asks the clinic nurse about the minimum daily requirement for protein. How many grams of protein will the nurse recommend?
53
A 76-yr-old woman with a body mass index (BMI) of 17 kg/m2 and a low serum albumin level is being admitted by the nurse. Which assessment finding will the nurse expect to find?
Pitting edema
A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which prescribed action should the nurse take first?
Place the patient on NPO status.
Which action for a patient receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG) may be delegated to a licensed practical/vocational nurse (LPN/LVN)?
Providing skin care to the area around the tube site
Which finding in the mouth of a patient who uses smokeless tobacco is suggestive of oral cancer?
Red, velvety patches on the buccal mucosa
A 19-yr-old woman admitted with anorexia nervosa is 5 ft, 6 in (163 cm) tall and weighs 88 lb (41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which patient problem has the highest priority?
Risk for electrolyte imbalance
A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports "feeling too tired to eat." Which action should the nurse take first?
Serve multiple small feedings of high-calorie, high-protein foods.
A patient is receiving continuous enteral nutrition through a small-bore silicone feeding tube. What should the nurse plan for when this patient has a computed tomography (CT) scan ordered?
Shut the feeding off 30 to 60 minutes before the scan.
A patient who has just been started on tube feedings of full-strength formula at 100 mL/hr has 6 diarrhea stools the first day. Which action should the nurse plan to take?
Slow the infusion rate of the tube feeding.
The nurse is caring for a 47-yr-old female patient who is comatose and is receiving continuous enteral nutrition through a soft nasogastric tube. The nurse notes the presence of new crackles in the patient's lungs. In which order will the nurse take action? (Put a comma and a space between each answer choice [A, B, C, D].)
Stop administering the continuous feeding. Check the patient's oxygen saturation. Measure the tube feeding residual volume. Notify the patient's health care provider.
After sleeve gastrectomy, a 42-yr-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?
Support the surgical incision during patient coughing and turning in bed.
After abdominal surgery, a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which is the best indicator that the patient is receiving adequate nutrition?
Surgical incision is healing normally.
Which assessment should the nurse perform first for a patient who just vomited bright red blood?
Taking the blood pressure (BP) and pulse
The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What information is most important to report to the health care provider?
Temperature 102.1°F (38.9°C)
The nurse receives the following information about a 51-yr-old female patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure?
The patient declined to drink the prescribed polyethylene glycol (GoLYTELY).
A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which assessment finding is most important for the nurse to address immediately?
The patient has no breath sounds in the left anterior chest.
A 58-yr-old patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse?
The patient is lethargic and difficult to arouse.
Which finding for a patient who has been taking orlistat (Xenical) is most important to report to the health care provider?
The patient is pale and has many bruises.
A 20-yr-old woman is being admitted with electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider?
The patient's serum potassium level is 2.9 mEq/L.
Which information about an 80-yr-old male patient at the senior center is of most concern to the nurse?
Unintended weight loss
Which information in this male patient's electronic health record as shown in the accompanying figure will the nurse use to confirm that the patient has metabolic syndrome (select all that apply)?
Waist size Blood glucose
The nurse is coaching a community group for individuals who are overweight. Which participant behavior is an example of the best exercise plan for weight loss?
Walking for 40 minutes 6 or 7 days/week
Which information about dietary management should the nurse include when teaching a patient with peptic ulcer disease (PUD)?
"Avoid foods that cause pain after you eat them."
The nurse is assessing an alert and independent 78-yr-old patient for malnutrition risk. Which is the most appropriate initial question?
"Can you tell me the food that you ate yesterday?"
A few months after bariatric surgery, a 56-yr-old male patient tells the nurse, "My skin is hanging off of me. I think I might want to surgery to remove the skinfolds." Which response by the nurse is most appropriate?
"Cosmetic surgery may be possible once your weight has stabilized."
After change-of-shift report, which patient will the nurse assess first?
A 40-yr-old man with continuous enteral feedings who has developed pulmonary crackles
Which of the nurse's assigned patients should be referred to the dietitian for a complete nutritional assessment (select all that apply)?
A 48-yr-old patient with rheumatoid arthritis who takes prednisone daily A 23-yr-old patient who has a history of fluctuating weight gains and losses A 64-yr-old patient who is admitted for débridement of an infected surgical wound
Which patient should the nurse assess first after receiving change-of-shift report?
A patient with esophageal varices who has a blood pressure of 92/58 mm Hg
Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment?
Absent bowel sounds
A malnourished patient is receiving a parenteral nutrition (PN) infusion containing amino acids and dextrose from a bag that was hung with a new tubing and filter 24 hours ago. The nurse observes that about 50 mL remain in the PN container. Which action is best for the nurse to take?
Add a new container of PN using the current tubing and filter.
Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood?
Administer 1 L of lactated Ringer's solution.
An adult with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. Which prescribed action will the nurse question?
Administer loperamide (Imodium) after each stool.
A 53-yr-old male patient with deep partial-thickness burns from a chemical spill in the workplace experiences severe pain followed by nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea?
Administer the prescribed morphine sulfate before dressing changes.
A patient has peptic ulcer disease that has been associated with Helicobacter pylori. About which medications will the nurse plan to teach the patient?
Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
To evaluate an obese patient for adverse effects of lorcaserin (Belviq), which action will the nurse take?
Ask about bowel movements.
Which nursing action is appropriate when coaching obese adults enrolled in a behavior modification program?
Asking the adults about situations that tend to increase appetite
A young adult been admitted to the emergency department with nausea and vomiting. Which action could the RN delegate to unlicensed assistive personnel (UAP)?
Assist the patient with oral care.
A patient is being admitted for bariatric surgery. Which nursing action can the nurse delegate to unlicensed assistive personnel (UAP)?
Assist with IV insertion by holding adipose tissue out of the way.
Which information will the nurse include when teaching adults to decrease the risk for cancers of the tongue and buccal mucosa?
Avoid use of cigarettes and smokeless tobacco.
When teaching a patient about testing to diagnose metabolic syndrome, which topic would the nurse include?
Blood glucose test
Which menu choice best indicates that the patient is implementing the nurse's suggestion to choose high-calorie, high-protein foods?
Fried chicken with potatoes and gravy
A young adult with extensive facial injuries from a motor vehicle crash is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which action will the nurse include in the plan of care?
Check the gastric residual volume every 4 to 6 hours.
Which assessment action will help the nurse determine if an obese patient has metabolic syndrome?
Check the patient's blood pressure.
A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action should the nurse take?
Check the vital signs.
Which patient choice for a snack 3 hours before bedtime indicates that the nurse's teaching about gastroesophageal reflux disease (GERD) has been effective?
Cherry gelatin with fruit
Which action should the nurse take first when preparing to teach a frail 79-yr-old Hispanic man who lives with an adult daughter about ways to improve nutrition?
Determine who shops for groceries and prepares the meals.
Which item should the nurse offer to the patient who is to restart oral intake after being NPO due to nausea and vomiting?
Dish of lemon gelatin
The nurse will be teaching self-management to patients after gastric bypass surgery. Which information will the nurse plan to include?
Drink fluids between meals but not with meals.
Which nursing action should be included in the postoperative plan of care for a patient after a laparoscopic esophagectomy?
Elevate the head of the bed to at least 30 degrees.
The nurse is caring for a patient on the first postoperative day after a Roux-en- gastric bypass procedure. Which assessment finding should be reported immediately to the surgeon?
Emesis of bile-colored fluid past the nasogastric (NG) tube
A 60-yr-old man who is hospitalized with an abdominal wound infection has been eating very little and states, "Nothing on the menu sounds good." Which action by the nurse will be most effective in improving the patient's oral intake?
Have family members bring favorite foods.
A patient's peripheral parenteral nutrition (PN) bag is nearly empty, and a new PN bag has not arrived yet from the pharmacy. Which intervention by the nurse is appropriate?
Infuse 5% dextrose in water until a new PN bag is delivered.
A 49-yr-old man has been admitted with hypotension and dehydration after 3 days of nausea and vomiting. Which prescribed action will the nurse implement first?
Infuse normal saline at 250 mL/hr.
Which information will the nurse prioritize in planning preoperative teaching for a patient undergoing a Roux-en- gastric bypass?
Instructing the patient on coughing and breathing techniques
A 30-yr-old male patient with a body mass index (BMI) of 22 kg/m2 is being admitted to the hospital for elective knee surgery. Which assessment finding is important to report to the health care provider?
Liver edge 3 cm below the costal margin
What information will the nurse include for an overweight 35-yr-old woman who is starting a weight-loss plan?
Low carbohydrate diets lead to rapid weight loss but are difficult to maintain.
Which adult will the nurse plan to teach about risks associated with obesity?
Man with a 42 in waist and 44 in hips
Which action should the nurse in the emergency department anticipate for a young adult patient who has had several episodes of bloody diarrhea?
Obtain a stool specimen for culture.
A 73-yr-old patient is diagnosed with stomach cancer after an unintended 20-lb weight loss. Which nursing action will be included in the plan of care?
Offer supplemental feedings between meals.
The nurse is planning care for a patient who is chronically malnourished. Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?
Offer the patient the prescribed nutritional supplement between meals.
A 58-yr-old patient has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene?
Offering the patient a pitcher of water
A patient has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider?
The oral temperature is 101.4°F.
A 42-yr-old patient is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled?
The patient ate a low-fat bagel 4 hours ago for breakfast.
A 38-year old woman receiving chemotherapy for breast cancer develops a Candida albicans oral infection. The nurse will anticipate the need for
administration of nystatin tablets.
An older patient reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation
after eating breakfast.
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take
antacids after meals and sucralfate 30 minutes before meals.
A severely malnourished patient reports that he is Jewish. The nurse's initial action to meet his nutritional needs will be to
ask the patient about food preferences.
After successfully losing 1 lb weekly for several months, a patient at the clinic has not lost any weight for the past month. The nurse should first
ask the patient whether there have been any changes in exercise or diet patterns.
A 68-yr-old male patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient's
breath sounds.
When caring for a patient with a history of a total gastrectomy, the nurse will monitor for
cobalamin (vitamin B12) deficiency.
A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago complains of increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. The highest priority action by the nurse is to
contact the surgeon.
A 26-yr-old patient with a family history of stomach cancer asks the nurse about ways to decrease the risk for developing stomach cancer. The nurse will teach the patient to avoid
emotionally stressful situations.
The nurse will anticipate preparing an older patient who is vomiting "coffee-ground" emesis
endoscopy.
When caring for a patient with a soft, silicone nasogastric tube in place for enteral feedings, the nurse will
flush the tubing after checking for residual volumes.
A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks the nurse about the purpose of receiving famotidine (Pepcid). The nurse will explain that the medication will
inhibit development of stress ulcers.
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
lie down for about 30 minutes after eating.
A patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for the management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about
misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa.
An older patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place. The health care provider prescribes 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse
periodically aspirates and tests gastric pH.
After assisting with a needle biopsy of the liver at a patient's bedside, the nurse should
place the patient on the right side with the bed flat.
To palpate the liver during a head-to-toe physical assessment, the nurse
places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin.
A patient has a body mass index (BMI) of 31 kg/m2, a normal C-reactive protein level, and low serum transferrin and albumin levels. The nurse will plan patient teaching to increase the patient's intake of foods that are high in
protein.
The nurse will anticipate teaching a patient experiencing frequent heartburn about
proton pump inhibitors.
A patient's capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion. The appropriate action by the nurse is to
recheck the capillary blood glucose level in 4 to 6 hours.
While interviewing a young adult patient, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient's knowledge about
risk for developing colorectal cancer.
The nurse will plan to monitor a patient with an obstructed common bile duct for
steatorrhea.
When a patient is diagnosed with achalasia, the nurse will teach the patient that
treatment may include endoscopic procedures.
The nurse explaining esomeprazole (Nexium) to a patient with recurring heartburn describes that the medication
treats gastroesophageal reflux disease by decreasing stomach acid production.
A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about
use of nonsteroidal antiinflammatory drugs (NSAIDs).
