*Med surg Exam 1*
Cirrhosis
Chronic disease of the liver, when healthy tissue gets replaced by scarred tissue, making "Liver Scar-osis"
Diuretic
If a pt is taking a beta blocker; the next recommended med would be?
Purple discoloration of stoma
A nurse is providing care for bowel obstruction for a transverse colostomy. Which finding requires immediate HCP notifying?
Liver function
-Detoxify ammonia, -Drug metabolism, -Storing glycogen, -Produce bile, -Coagulation factors, -Albumin
-Maintain NPO status -Encourage coughing & deep breathing -Give hydromorphone IV as prescribed for pain
A nurse is reviewing a prescription for a client diagnosis of acute pancreatitis. Which intervention would be prescribed?
smoking, inactive exercise, unhealthy diet
A 40 year old is at risk for colon cancer, what are the modifiable (changeable) risk factors?
-Gray-blue color at the flank -Abdominal guarding and tenderness -Left upper quadrant pain with radiation to the back
A client admitted to the hospital with a suspected diagnosis of Acute pancreatitis is being assessed by the nurse. Which assessment findings would be consistent with acute pancreatitis? Select all that apply.
Lying recumbent after meals
A client has Hiatal Hernia (stomach protrudes) what is contraindicated after an experience of heartburn after meals? Rationale: Blocks under the bed, pillow, 2hrs before laying down. Patho: Stomach protruding through diaphragm
Nausea and vomiting
A client has an as-needed prescription for ondansetron. For which condition(s) should the nurse administer this medication?
Rigid board-like abdomen
A client has been diagnosed with peptic ulcer disease and there is perforation of the ulcer. What would be the S&S the client will experience? -Tachycardia -Nausea/vomiting
Malaise
A client has developed Hepatitis A after eating contaminated oysters. The nurse assesses the client for which of the following? Hep A transmission- Fecal oral, seafood, daycare Rationale: Hepatitis A causes gastrointestinal symptoms such as anorexia, nausea, right upper quadrant discomfort, and weight loss. Fatigue and malaise are common. Stools will be light- or clay-colored if conjugated bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts.
-Administer stool softeners as prescribed -Encourage a high fiber diet to promote bowel movements without straining -Apply cold packs to the anal-rectal area over the dressing until the packaging is removed
A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply.
Irrigating the NG tube
A client has peptic ulcer disease and underwent a Gastrojejunostomy (connects stomach to jejunum). Which prescription would the nurse question? Rationale: Let the digestive system rest
Assessing for return of the gag reflex
A client has undergone Esophagogastroduodenoscopy (EGD). The nurse should place highest priority on which item as part of the client's care plan?
DO NOT STOP treatment, HCP will do a broad spectrum (one ABX that fix all the problems)
A client is admitted to the hospital with a treatment for pneumonia after complaining of having high fever & shortness of breath, the client was NOT able to give a sputum culture, what should the nurse do next?
Increase intake of fluids, including juices.
A client is admitted to the hospital with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? Although no special diet is required to treat viral hepatitis, it is generally recommended that clients consume a low-fat diet as fat may be tolerated poorly because of decreased bile production. Small, frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning, so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 mL/day that includes nutritional juices is also important.
Checking the frequency and consistency of bowel movements
A client with Crohn's disease is scheduled to receive an infusion of infliximab. What intervention by the nurse will determine the effectiveness of treatment?
-Fluid & electrolyte imbalance
A client with severe Crohn's disease has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which of the most frequent complication of this type of surgery?
Document the stoma as healthy and well perfused
A nurse is administering Stoma care, it appears shiny & bright red.
Narrow therapeutic index
A nurse is caring for a client who is receiving ABX, the nurse notes the HCP is ordering peaks & troughs, what would be the indication for this?
We are concerned about kidneys and renal status and allergies of iodine or shellfish
A patient with an Upper GI with barium swallow (swallowing contrast) -Make sure pt is flushing barium out, stool will be white & chalky, will also cause constipation so increase fluids to get that contrast out before it gets lodged.
Administer IV fluids (ABCs)
A pt has Acute diverticulitis (infected inflamed bowel), what should the nurse do? Rationale: The BP is going down, the pt needs blood volume because of circulation issue or pt will die.
stroke
A pt in the ICU with hypertensive crisis, the pt cannot move arms and legs when asked to do so.. this indicates? -Chest pains may indicate Heart attack
The pt will not stop medication, the nurse will administer an ARB
A pt is on a ACE inhibitor and it is causing a dry hacking cough, what will be the next action for the nurse?
-Perforation -Infection/sepsis -Hypo/hyperglycemia -Electrolyte imbalance -Blood clots -Liver failure
Complications of having a central line?
Limit the fluids taken with meals.
Following a Gastrectomy (removal of stomach), which instructs the client to assist in preventing dumping syndrome?
-Obtain cultures & sensitivities before starting ABX -Finish all ABX, don't share prescriptions
How do you prevent bacteria resistance while taking ABX?
Monitor weight & ABD girth, it will eventually start compromising the respiratory system.
If a patient with Portal HTN is experiencing liver problems, what should the nurse do? *When the liver is sick everything backs up into the stomach causing Ascites, with lots of fluid*
Administer Lactulose
Pt has hepatic encephalopathy (ammonia in the brain) and confused, shortness of breath, fatigue decreased LOC, hx of alcohol abuse, only arouse to shouting and shaking. What medication should the nurse administer? -Do not ambulate pt to bathroom pt is at risk for falls also with showers as well (contraindicated) Somnolent means hard to arouse.
Report to HCP a superinfection, as a SE of the cephalosporin.
Pt took cephalosporin for 2 weeks, has signs of cheesy-white like substance on the tongue, thrush, what does this indicate
This is a normal, expected event
The client had a new colostomy created 2 days earlier. The client is beginning to pass malodorous flatus from the stoma. The nurse interprets that.
"I ate shellfish about 2 weeks ago at a local restaurant."
The health care provider has determined that a client has contracted Hepatitis A based on Flu like symptoms and jaundice. Which statement made by the client supports this medical diagnosis? -Hep C is the only one that doesn't develop jaundice Rationale: Hepatitis A is transmitted by the fecal-oral route via contaminated water or food (improperly cooked shellfish), or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids, such as in the cases of intravenous drug abuse, history of blood transfusion, or unprotected sex with multiple partners.
"I'm glad I don't have to lie still for this procedure."
The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further information if the client makes which statement? Rationale: The client does have to lie still for ERCP, which takes about 1 hour to perform. The client also has to sign a con- sent form. Intravenous sedation is given to relax the client, and an anesthetic spray is used to help keep the client from gagging as the endoscope is passed.
Document these findings
The nurse is assessing a client 24 hours following a cholecystectomy (removal of gallbladder). The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate? Rationale: Following cholecystectomy, drainage from the T-tube is initially bloody and then turns a greenish-brown color. The drainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day. The nurse would document the output.
Right upper quadrant, radiating to the right scapula and shoulder
The nurse is assessing a client who is experiencing an acute episode of cholecystitis (inflammation of gallbladder) Where should the nurse anticipate the location of the pain?
-Fever -Complaints of indigestion -Pain in the upper right quadrant after a fatty meal
The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Which of these clinical manifestations support this diagnosis? Select all that apply
Pain relieved by food intake
The nurse is doing a assessment on a client with a history of Duodenal ulcer. To determine whether the problem is currently active, the nurse would assess the client for which manifestation of duodenal ulcer?
Notify the health care provider (HCP).
The nurse is monitoring a client admitted to the hospital with a diagnosis of Appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention?
Sweating and pallor
The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? Rationale: Early manifestations of dumping syndrome occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.
-Coffee -Chocolate -Peppermint -Fried chicken
The nurse is planning to teach a client with Gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? Select all that apply
-Nuts -Liver -Lentils
The nurse is providing dietary teaching for a client with a diagnosis of chronic gastritis. The nurse instructs the client to include which foods rich in vitamin B12 in the diet? Select all that apply.
"I need to increase the fiber in my diet"
The nurse is providing discharge teaching for a client with newly diagnosed Crohn's disease (healthy & unhealthy patches) about dietary measures to implement during exacerbation episodes. Cobblestone appearance Patches from Mouth to anus Which statement by the client indicates a need for further teaching?
Pasta with sauce
The nurse is reviewing the laboratory results for a client with Cirrhosis and notes that the ammonia level is 85 mcg/dl. Which dietary selection does the nurse suggest? Rationale: Pasta doesnt have protein
ask the client to extend the arms
The nurse is reviewing the record of a client with a diagnosis of Cirrhosis and notes that there is documentation of the presence of Asterixis. How should the nurse assess for its presence?
-Generalized itching -ABD swelling -Generalized bruising
What are symptoms of cirrhosis?
The pt will not stop taking the BP drug because the BP can increase again
Which of these indicate an understanding of a patient on antihypertensive meds?
Just read..
· Pt is getting Parenteral Nutrition (GI is not intact, not functioning properly from removal of GI etc. Goes through a central line, complications will be from the central line and peripheral nutrition itself, can puncture lung through central line, can become clotted and move causing Pneumothorax, can cause hyperglycemia because of yellow & white bags of nutrition) Enteral Nutrition (Gi is intact, NG tube is dropped down pts throat)
