Module 1

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A nurse is caring for a patient with diarrhea caused by a Clostridium difficile infection ,and the patient demands medication to stop the diarrhea .Which response would the nurse give the patient ? " Stopping antibiotics will cure the diarrhea ." " Antidiarrheal medications increase the risk of additional complications ." " Fluid and electrolyte replacement is enough to treat the diarrhea ." " The provider will decide whether or not to prescribe an antidiarrheal ."

" Antidiarrheal medications increase the risk of additional complications ."

Which common adverse effect is associated with famotidine? Dizziness Anorexia Jaundice Mild gynecomastia

Dizziness Rationale Dizziness is a common adverse effect of famotidine. Anorexia, jaundice, and mild bilateral gynecomastia are serious adverse effects of famotidine.

A nurse caring for a patient with peptic ulcer disease (PUD) knows to be vigilant for which sign of a life -threatening complication ? Melena Constipation Hypotension Hypothermia

Hypotension

Which type of ulcer has misoprostol been known to reduce? Stress Esophageal Helicobacter pylori Nonsteroidal antiinflammatory drug (NSAID)-induced

Nonsteroidal antiinflammatory drug (NSAID)-induced Rationale Misoprostol increases the level of prostaglandin E, which inhibits gastric acid and pepsin secretion. This medication counteracts the effects of NSAIDs, including aspirin, which will decrease the amount of prostaglandins in the stomach, thus predisposing an individual to gastric ulcers. Misoprostol is not effective against H. pylori ulcers, stress ulcers, or esophageal ulcers.

Which medication is prescribed when a patient is diagnosed with Helicobacter pylori infection but is asymptomatic? Select all that apply. Ranitidine (Zantac) Amoxicillin (Amoxil) Clarithromycin (Biaxin) Esomeprazole (Nexium) Dexlansoprazole (Dexilant)

Ranitidine (Zantac) Esomeprazole (Nexium) Dexlansoprazole (Dexilant) Rationale Histamine-2 antagonists such as ranitidine (Zantac) and proton pump inhibitors such as esomeprazole (Nexium) and dexlansoprazole (Dexilant) are used to treat Helicobacter pylori infection in asymptomatic patients. Antibiotics are not recommended in asymptomatic patients to reduce the development of more resistant strains of bacteria; amoxicillin (Amoxil) and clarithromycin (Biaxin) should not be prescribed.

Which intervention prescribed by the healthcare provider would be most effective in healing canker sores? Carbamide peroxide (Gly-Oxide) Hydrogen peroxide (Colgate Peroxyl) Zinc oxide Topical amlexanox paste 5% (Aphthasol)

Topical amlexanox paste 5% (Aphthasol) Rationale Topical amlexanox paste 5% (Aphthasol) is very effective in healing canker sores. Carbamide peroxide (Gly-Oxide) and hydrogen peroxide (Colgate Peroxyl) are debriding and cleansing agents, which help maintain oral hygiene but are not very effective in healing canker sores. Zinc oxide prevents or retards the formation of new calculi from plaque but will not remove calculus already formed.

A patient is scheduled to undergo T-tube cholangiography. Before administration of contrast dye, which allergy would the nurse check the patient for? lodine Peanuts Silk tape Strawberries

lodine Rationale Before administration of contrast dye, it is essential that the nurse determine if the patient has an allergy to iodine. Patients with iodine allergies may react to the contrast dye, and this reaction can be life-threatening. There has been no documentation that a strawberry allergy would place a patient at risk for an allergy to contrast dye; however, people who are allergic to strawberries are often allergic to other foods and substances. All allergies should be clearly documented on the appropriate part of the medical record. There has been no documentation that a peanut allergy would place the patient at risk for an allergy to contrast dye; however, people who are allergic to peanuts are often allergic to other foods and substances. There has been no documentation that an allergy to silk tape would place the patient at risk for an allergy to contrast dye. Any such allergy, which would manifest as redness near areas with silk tape, would be uncomfortable for the patient, but not life-threatening.

Which instructions does the nurse give to a patient being treated for oral candidiasis ?Select all that apply . " Include citrus fruits in your diet ." " Use a hard -bristled tooth brush ." " Avoid hot ,cold ,spicy ,and fried foods ." " Perform meticulous hand hygiene ." " Use anesthetic an hour before meals ."

" Avoid hot, cold , spicy, and fried foods ." " Perform meticulous hand hygiene ." " Use anesthetic an hour before meals ."

Which statement by a patient demonstrates an understanding of the role of normal bacteria in the colon ? " Bacteriain the colon metabolize toxins in the bloodstream ." " Bacteriain the colon produce vitamin K to help with clotting ." " Bacteriain the colon aid in the absorption of water from the stool." " Bacteriain the colon digest food for absorption into the bloodstream ."

" Bacteria in the colon produce vitamin K to help with clotting ." Rationale Normal bacterial flora of the colon produce vitamin K ,which is absorbed into the bloodstream and aids in clotting .The bacteria do not digest food for absorption ,absorb water ,or metabolize toxins .

A patient has developed dumping syndrome after peptic ulcer surgery .Which instructions are given to the patient for management of this disorder? Select all that apply . " Eat six small meals daily ." " Avoid fluids during meals ." " Recline for 1 hour after meals ." " Increase carbohydrates in your diet ." " Increase protein and fat in your diet ."

" Eat six small meals daily ." " Avoid fluids during meals ." " Recliner 1 hour after meals ." " Increase protein and fat in your diet ."

Which instruction is important to give to a patient after an upper gastrointestinal ( GI)study ? " Increase your fluid intake ." " Avoid smoking for 3 days ." " Avoid food for some time ." " Take the prescribed antacids ."

" Increase your fluid intake ." Rationale The upper study involves a series of radio graphs of the lower esophagus ,stomach ,and duodenum ,using barium sulfate as the contrast medium .Therefore ,the patient needs to increase fluid intake after the test to expel the barium and prevent constipation .Smoking is avoided in order to improve overall health and is not associated with with tte test .Food is avoided for some time after endoscopy ,until the gag reflex returns .There is no need need need to avoid food after an upper Gl study .There are no side effects ,such as nausea ,vomiting ,or heartburn ,after the upper study ,and therefore ,antacids are not prescribed .

Which dietary instruction does the nurse give to a patient scheduled for colonoscopy ? " Start a gluten -free diet a week before the test ." " Increase dietary fiber and yogurt a week before the test ." " Maintain a clear liquid diet for 1 to 3 days before the procedure ." " Maintain nothing -by-mouth (NPO) status for 12 hours prior to the test ."

" Maintain a clear liquid diet for 1 to 3 days before the procedure ." Rationale The nurse instructs the patient to consume only clear liquids for 1 to 3 days before the procedure to decrease the residue in the bowel .A gluten -free diet is important for a patient with celiac disease and is not a requirement for the test .Dietary fiber and yogurt are increased in the diet to reduce bloating if a patient has irritable bowel syndrome .The patient needs to maintain NPO status for 8 hours before the test .

A patient is prescribed lansoprazole (Prevacid) and sucralfate (Carafate) for stomach ulcers caused by gastroesophageal reflux disease (GERD). Which instruction is most important to this patient ? " Take both medications with fruit juice ." " Take both medications at bedtime after a meal ." " Take lansoprazole 30 minutes before sucralfate ." " Increase fluids to prevent constipation and dry mouth ."

" Take lansoprazole 3 0 minutes before sucralfate ." Rationale Sucralfate Carafate) decreases absorption of lansoprazole (Prevacid) if they are taken at the same time .Therefore ,the patient needs to take the medications with a 3 0-minuteinterval .The medications can be taken with water or fruit juice .However ,not a priority instruction in this case .The medications are taken before meals to reduce the amount of stomach acid .The medications do not cause constipation or dry mouth .Instead ,the patient may experience diarrhea and abdominal pain .

A patient who recently had an appendectomy asks the nurse ," Are there any undesirable effects of removing the appendix ? "Which response by the nurse is appropriate ? " You may have some digestive problems ." " Only if you have inflammatory bowel disease (IBD)." " The appendix has no known digestive function ." " The role of the appendix is taken up by the cecum ."

" The appendix has no known digestive function ." Rationale The vermiform appendix attaches to the cecum of the ascending colon and has no known digestive function .Removal of the appendix has not been shown to lead to any digestive problems .The appendix -orits absence -is not involved in IBD .IBD is worsened by low fiber intake .The cecum receives chyme from the ileum and connects to the ascending colon of the large intestine .

Which statement by the student nurse indicates effective learning about the function of the hypothalamus ? " The hypothalamus influences eating habits ." " The hypothalamus aids in sensory perception ." " The hypothalamus aids in the synthesis of vitamin K ." " The hypothalamus aids in the absorption of metabolized fats ."

" The hypothalamus influences eating habits ." Rationale The hypothalamus is located in the brain and contains two appetite centers that have an effect on eating .One center stimulates the individual to eat ,and the other signals the individual to stop eating .The thalamus is another part of the brain ,which is involved in sensory perception .The bacteria in the large intestine are responsible for the synthesis of vitamin K .The lymph capillaries within the small intestine ,called lacteals ,absorb metabolized fats .

A patient with carcinoma of the esophagus is about to undergo surgery ,an esophagogastrectomy ,and is very anxious about what to expect immediately after surgery .Which statement would be appropriate to help alleviate the patient 's anxiety ? " My father had this type of surgery before he died ,and he said it went very well ." " Don't worry ;cancer survival rates have greatly improved for this disease ." " When you wake up ,we will be monitoring you very closely and keep you as comfortable as possible ." " This surgery involves resection of a lower esophageal section with a proximal portion of the stomach ."

" When you wake up ,we will be monitoring you very closely and keep you as comfortable as possible ."

Which question is appropriate to assess a patient's nutritional status? "How often do the stressors occur?" "Have there been any changes in taste?" "Have there been any changes in stool color or consistency or in bowel elimination?" "Are there any food allergies or foods that cause gastric distress when eaten?"

"Are there any food allergies or foods that cause gastric distress when eaten?" Rationale Food allergies or foods that particularly cause gastric distress when eaten should be determined because they may increase acidity and cause gastroesophageal reflux disease. Asking the patient about stressors and their occurrences would help assess anxiety or stress levels. Asking about changes in taste such as bitterness would help determine the cause of abdominal pain or discomfort. Asking about changes in stool color or consistency or in bowel elimination would determine the history of diseases or disorders.

Which instruction would the nurse provide to ensure drug safety in a patient who has been prescribed propantheline (Pro-Banthine) for spasms in the liver? "Take the drug only in the morning." "Avoid alcohol intake along with the drug." "Discontinue the drug if you develop chest pain." "Take an anti-emetic medication along with the drug."

"Avoid alcohol intake along with the drug." Rationale Drowsiness and confusion are side effects of using propantheline (Pro-Banthine). The patient is advised to avoid the use of central nervous system (CNS) depressants or alcohol when taking the drug. Spironolactone (Aldactone) is taken in the morning to avoid interference with sleep. Vasopressin (Pitressin) should be discontinued if chest pain develops. The patient is prescribed gemcitabine hydrochloride (Gemzar) with an antiemetic drug to control nausea and vomiting.

A patient in the clinic has been diagnosed with acute viral hepatitis caused by hepatitis B virus. The patient requests that the nurse not tell anyone about his infection. Which response by the nurse would be best? "By law, I have to notify all of your sexual partners." "By law, I have to notify your family." "By law, I have to notify the Centers for Disease Control and Prevention (CDC).!" 'By law, I have to notify all of your sexual partners and the CDC.

"By law, I have to notify the Centers for Disease Control and Prevention (CDC).!" Rationale The nurse should tell the patient that the law requires all cases of viral hepatitis to be reported to the CDC. Although the nurse cannot tell the patient's partners, the patient should be encouraged to inform the partners so that they may seek testing and treatment in timely fashion. Health information is protected by the Health Insurance Portability and Accountability Act (HIPAA) and is not to be released to any family unless the patient consented to tell his or her family.

Which instructions would the nurse give to a patient with acute pancreatitis during dietary teaching? Select all that apply. "Consume a low-fat diet." "Avoid consuming alcohol." "Avoid taking too much fluid." "Consume a high-protein diet." "Consume a low-carbohydrate diet."

"Consume a low-fat diet." "Avoid consuming alcohol." "Consume a high-protein diet." Rationale Consuming a low fat diet is essential in case of pancreatitis. Fats should be avoided because they stimulate the secretion of cholecystokinin, which then stimulates the pancreas. Alcohol is an irritant and must be avoided. A diet high in protein content is recommended. Fluid intake should be increased to prevent dehydration. Carbohydrates are less stimulating to the pancreas and are encouraged.

Which preventive measures would the nurse instruct to prevent common respiratory complications in a patient who underwent liver transplantation? Select all that apply. "Cough and deep breathe." "You should sneeze." "Breathe rapidly." "You should reposition frequently." "You should use the incentive spirometer."

"Cough, and deep breathe." "You should reposition frequently." "You should use the incentive spirometer." Rationale Common respiratory problems that occur after liver transplantation in a patient include pneumonia, atelectasis (collapsed lung), and pleural effusions. Have the patient use such measures as coughing, deep breathing, incentive spirometry, and repositioning to prevent these complications. Sneezing and rapid breathing do help prevent respiratory complications.

Which question would the nurse ask about activity and exercise while completing a focused assessment on a patient with suspected gastroesophageal reflux disease? "How frequently do you exercise?" "Are you able to tolerate moderate physical activity?" "Does your exercise routine include strengthening exercises?" "Do you do any activities that include bending over frequently?"

"Do you do any activities that include bending over frequently?" Rationale The nurse questions the patient about any activities that can increase intraabdominal pressure such as bending over frequently or lifting heavy objects. Asking how frequently the patient exercises, how well they tolerate moderate physical activity, and if the exercise routine includes strengthening exercises are all general activity- and exercise-related questions that would not necessarily provide information pertinent to the patient's disease.

Which questions does the nurse ask to assess a patient who complains of difficulty eating and talking and has a burning sensation on the tongue with an accompanying loss of taste? Select all that apply. "Do you smoke?" "Do you have depression?" "Do you use any corticosteroids?" "Do you have diabetes mellitus?" "Are you under extreme physical stress?"

"Do you smoke?" "Do you have depression?" "Do you have diabetes mellitus?" Rationale Xerostomia is a condition in which the flow of saliva is either partially or completely blocked. It is associated with a loss of taste and difficulty in chewing, talking, and swallowing food. This condition may also cause a burning sensation on the tongue. Smoking, depression, and diabetes mellitus are associated with xerostomia. A common predisposing factor for candidiasis is the use of corticosteroids. Extreme physical stress and fatigue may cause cold sores.

Which statements are inappropriate to tell a patient with regards to antacid therapy? Select all that apply. "For indigestion, antacids can be administered for more than 2 weeks." "Calcium carbonate and sodium bicarbonate may cause rebound hyperacidity." "Large quantities of antacids can effectively manage acute ulcer disease." "Patients with renal failure should use large quantities of antacids containing magnesium." "Antacids should be used only by patients with occasional indigestion or heartburn."

"For indigestion, antacids can be administered for more than 2 weeks." "Large quantities of antacids can effectively manage acute ulcer disease." "Patients with renal failure should use large quantities of antacids containing magnesium." Rationale Antacids should not be administered for more than 2 weeks to treat indigestion. Effective management of acute ulcer disease requires large volumes of antacids to reduce hyperacidity and neutralize stomach acids. Calcium carbonate and sodium bicarbonate may cause rebound hyperacidity by increasing gastric secretion. Only patients with occasional indigestion or heartburn should use antacid tablets. Excessive use may cause diarrhea or constipation. Patients with renal failure should not use large quantities of antacids containing magnesium because of the risk of developing hypomagnesemia.

A patient suffering from cholelithiasis underwent a cholecystectomy. Which dietary advice would the nurse give this patient? Select all that apply. "Have a high-fiber diet." "Limit intake of water." "Resume your normal diet." "Have small, frequent meals." "Avoid fat or keep it to the minimum."

"Have a high-fiber diet." "Have small, frequent meals." "Avoid fat or keep it to the minimum." Rationale Having a high-fiber diet helps in the smoother passage of stools and prevents constipation. Having small, frequent meals helps digestion and prevents nausea. Fats make it harder to digest, SO fat should be avoided. After cholecystectomy, it is essential that the patient take adequate intake of water, around 2500 to 3000 mL/day. The patient should not have the usual foods; modifications are needed to facilitate easy digestion of food in the absence of the gall bladder.

Which question asked by the nursing student indicates the need for further education on how to obtain information about a patient's dental history? "Do you have any difficulty in speaking?" "How many times a day do you brush your teeth?" "Which toothpaste and mouthwash do you use?" "Have you been to a dentist in the past 6 months?"

"Have you been to a dentist in the past 6 months?" Rationale The nurse should obtain the patient's dental history for the past 1 to 3 years, not the past 6 months. The nurse should ask the patient if he or she experiences difficulty speaking, chewing, and swallowing. The nurse should ask the patient about daily hygiene practices such as how many times the patient brushes his or her teeth. The nurse should ask the patient about any oral products, such as mouthwash and toothpaste, which the patient uses.

Which statement by the patient helps the nurse understand the reason for a lack of improvement while taking 400 mg sustained-release oral lansoprazole? "I am not crushing the tablet." "I am chewing the tablet thoroughly." "I am swallowing the tablet whole." "I am taking the tablet before meals."

"I am chewing the tablet thoroughly." Rationale A sustained-release capsule should not be chewed as this causes the release of all the medication and makes the sustained-release aspect of the medication ineffective. The patient should avoid crushing the tablet for the same reason. Swallowing the tablet whole can result in an effective outcome. Proton pump inhibitors such as lansoprazole are effective when taken on an empty stomach.

Which information provided by the patient indicates the need for additional instruction concerning nutritional intake with a gastric disorder? Select all that apply. "I should avoid late-night snacks or meals." "I should drink a large amount of fluid with the meals." "I should avoid coffees, teas, colas, and alcoholic beverages." "I should increase protein foods and fats to about 50 g per day." "I should eat small, more frequent meals to support optimal energy requirements and healing."

"I should drink a large amount of fluid with the meals." "I should increase protein foods and fats to about 50 g per day." Rationale The patient should drink a small amount of water with meals and between meals and not a large amount because it may result in indigestion. A patient with a gastric disorder should increase protein intake and decrease fat intake to about 45 g per day. The patient should avoid late-night snacks or meals because they may result in increased gastric secretions. The patient should avoid coffees, teas, colas, and alcoholic beverages because they may cause hyperacidity. The patient should eat small, more frequent meals to support optimal energy requirements and promote healing.

Which statement of the patient needs to be corrected concerning the self- management of canker sores? "I will eat pineapple and citrus fruits." "I will use saline rinses in 4 to 8 ounces of warm tap water." " will apply amlexanox (Aphthasol) four times a day after meals." "I will apply oxygen-releasing agents for cleansing, at appropriate intervals."

"I will eat pineapple and citrus fruits." Rationale Pineapples and citrus fruits can irritate the sores. The patient may experience a soothing effect by using saline rinses in 4 to 8 ounces of warm tap water. An application of amlexanox (Aphthasol) after meals and oral hygiene will help treat the sores; this action should be done four times daily. The patient should apply oxygen-releasing agents for cleansing at appropriate intervals.

Which statement of the patient needs to be corrected concerning the self-management of canker sores? "I will eat pineapple and citrus fruits." "I will use saline rinses in 4 to 8 ounces of warm tap water." "I will apply amlexanox (Aphthasol) four times a day after meals." "I will apply oxygen-releasing agents for cleansing, at appropriate intervals."

Which statement made by the patient indicates a need for further education about canker sores and healing? Select all that apply. "I will place aspirin on the lesions." "I will take acetaminophen." "| will use benzocaine 10% after eating." " will use topical amlexanox after meals and four times a day." "I will use hydrogen peroxide (Colgate Peroxyl) four times a day for 7 days."

"I will place aspirin on the lesions." "| will use benzocaine 10% after eating." Rationale Aspirin should not be placed on the canker sores because this action increases the risk of severe chemical burns with necrosis. Benzocaine 10% helps relieve pain from cold sores. Acetaminophen should be administered to relieve pain. Apply amlexanox after meals and oral hygiene, four times daily. Hydrogen peroxide is a cleansing agent and should be used four times a day for 7 days.

Which statements made by the patient need to be corrected concerning interventions to treat oral pain caused by mucositis? Select all that apply. "I will take morphine for moderate pain." "I will apply sucralfate suspensions topically." "I will rinse my mouth with magnesium hydroxide (Milk of Magnesia). "I will swish and swallow nystatin liquid suspension." "I will use lidocaine viscous 2% (Xylocaine Viscous 2%) after meals."

"I will take morphine for moderate pain." "I will use lidocaine viscous 2% (Xylocaine Viscous 2%) after meals." Rationale Morphine should only be administered for severe oral pain. Lidocaine viscous 2% (Xylocaine Viscous 2%) should be used before (not after) meals to relieve oral pain, but the patient should be educated that the gag reflex will be suppressed. Sucralfate suspensions should be applied topically for effective pain relief. Patients with mucositis should rinse their mouths and coat the mucous membranes with magnesium hydroxide (Milk of Magnesia) for oral pain relief. Nystatin liquid suspension should be first swished and then swallowed to reduce the risk of candidal oral infections.

Which statement made by the patient who is experiencing neutropenia indicates the need for further education about denture care? "I will brush the dentures regularly." "I will wear the dentures all the time." "I will get the dentures repaired if they are poorly fitted." "I will clean the dentures each time I perform oral hygiene."

"I will wear the dentures all the time." Rationale Neutropenic patients should wear dentures only while eating because wearing them all the time may cause irritation and may lead to further complications. The patient should brush the dentures regularly to prevent plaque formation. The dentures should be repaired immediately if they are poorly fitted to help prevent further tissue breakdown. The dentures should be cleaned each time oral hygiene is performed.

Which nursing response is accurate to a patient taking misoprostol (Cytotec) who reports having diarrhea after 2 weeks of therapy? "It will likely resolve in about 8 days." "Take the medication on an empty stomach." "Take a half dose of misoprostol (Cytotec)." "It will resolve if you take the medication with large amounts of water."

"It will likely resolve in about 8 days." Rationale After 2 weeks of therapy, diarrhea induced by misoprostol (Cytotec) should resolve within 8 days. Taking the medication on an empty stomach can increase the risk of diarrhea. Taking the medication with large amounts of water does not reduce the risk of diarrhea. Taking a half dose will not affect the recovery time from diarrhea.

Which instruction is beneficial to a patient taking metoclopramide? "Avoid taking the tablet at bedtime." "Take a tablet 30 minutes before meals." "Take the tablet along with an antihistamine." "Take the tablet with a small amount of water."

"Take a tablet 30 minutes before meals." Rationale Metoclopramide should be taken 30 minutes before a meal to ensure effective absorption. The patient should also take the medication at bedtime to ensure an effective outcome. Taking an antihistamine with metoclopramide will increase its sedative effects. Taking metoclopramide with a small amount of water may not result in effective drug absorption.

Which instruction regarding the administration of misoprostol is beneficial to this patient? "Take this medication along with food." "Take the tablet on an empty stomach." "Follow a fluid-restricted diet while taking this medication." "Limit whole-grain products while taking this medication."

"Take this medication along with food." Rationale An adult dose of misoprostol oral tablets is between 100 and 200 mcg; this medicine should be taken four times a day with food during nonsteroidal anti-inflammatory drug (NSAID) therapy. The patient should take this medication along with food to ensure a positive outcome. Taking the medication on an empty stomach can increase the risk of diarrhea. The patient should be sure to take in a lot of fluids. The patient should also eat sufficient roughage such as fruits, vegetables, and whole-grain products.

A nurse who is providing education to a patient with cirrhosis knows the importance of preventing bleeding. Which instruction would be most important to prevent bleeding? "Change position in bed often." "Use a soft-bristled toothbrush." "Strictly follow the therapeutic diet provided." "Avoid the use of perfumed lotions and soaps."

"Use a soft-bristled toothbrush." Rationale To prevent bleeding, the patient should use a soft-bristled toothbrush. The patient should also change position often, follow the therapeutic diet, and avoid use of perfumed lotions and soaps, but these instructions do not help the patient prevent bleeding.

Which advice, if followed by the patient, may cause healthy tissue damage in the area surrounding a gray lesion on the tongue? "Use silver nitrate to cauterize the lesions." "Avoid the sustained use of camphor and eugenol." "Use a rinse of saline dissolved in 4 to 8 ounces of warm tap water." "Use oxygen-releasing agents for no more than 7 days."

"Use silver nitrate to cauterize the lesions." Rationale Canker sores may appear as ulcers on the tongue; the lesions are usually gray to whitish-yellow. The use of silver nitrate to cauterize these lesions should be avoided because this chemical may damage healthy tissues surrounding the lesion and predispose the area to a later infection. Sustained use of products that contain menthol, camphor, phenol, and eugenol should be discouraged because they can cause tissue irritation and damage or systemic toxicity if overused. The use of saline rinses may provide a soothing effect. This solution will not cause tissue damage. Oxygen-releasing agents can be used as debriding and cleansing agents up to four times daily for 7 days.

A patient with cirrhosis of the liver has ascites and is being prepared for a pal, would the nurse give the patient? "Fast overnight." "You should lie down during the procedure." "Avoid taking any fluids before paracentesis." "Void urine immediately before paracentesis."

"Void urine immediately before paracentesis." Rationale The nurse should instruct the patient to void prior to paracentesis to prevent accidental puncture of the bladder. During the procedure, the patient sits on the side of the bed or, is placed in high- Fowler's position. There is no need to keep the patient on NPO (nothing by mouth) status or to restrict fluid intake.

A patient with hepatitis A infection is being discharged from the hospital. Which instruction is most important for the nurse to include in the discharge teaching? "Avoid sharing razors or toothbrushes." "Wash hands carefully after bowel movements." "Avoid close contact with other family members." "Take acetaminophen every 4 hours, if fever persists."

"Wash hands carefully after bowel movements." Rationale The mode of transmission of hepatitis A infection is the fecal-oral route. Therefore, it is very important to maintain personal and environmental hygiene. The nurse should teach the patient and the family members about washing hands after bowel movements and before eating to prevent outbreaks of hepatitis A viral infection. Not sharing toothbrushes and razors is a concern for the prevention of hepatitis B and C because it is transferred through blood contact. There is no need to isolate the patient with hepatitis A unless he or she is incontinent or maintains poor personal hygiene. Acetaminophen causes liver damage and should be avoided in hepatic viral infection.

Which information provided by the healthcare provider would be beneficial to a patient with severe oral lesions? "You should avoid cold drinks." "You should avoid bland foods." "You should add supplemental nutrition (Boost) to your diet." "You should add citrus juices to your diet."

"You should add supplemental nutrition (Boost) to your diet." Rationale Patients with severe oral lesions are advised to add supplemental nutrition formulas such as Ensure and Boost to their diets so that they can receive enough nutrition despite difficulty in eating. Patients should drink cold beverages to soothe the oral tissues. Patients should eat bland foods such as dairy products. Patient should avoid citrus juices because they may cause irritation.

Which nursing instruction would prevent tissue irritation and black hairy tongue in a patient with canker sores? "You should not use silver nitrate to cauterize the lesions." "You should avoid the long-term use of oxygen-releasing agents." "You should use saline rinses in 4 to 8 ounces of warm tap water." "You should apply benzocaine (Kank-A) before performing oral hygiene."

"You should avoid the long-term use of oxygen-releasing agents." Rationale Patients with canker sores can use oxygen-releasing agents as debriding and cleansing agents up to four times a day for 7 days. Long-term use may cause tissue irritation and black hairy tongue. Silver nitrate should not be used to cauterize canker sores because it may damage healthy tissue surrounding the lesions and promote secondary infection. Saline rinses can provide a soothing effect; their use does not prevent tissue irritation and black hairy tongue. Benzocaine (Kank-A) is particularly effective if applied just before eating or performing oral hygiene.

Which instructions are beneficial for a patient taking sucralfate who reports constipation and dry mouth? Select all that apply. "You should suck ice chips frequently." "You should avoid sucking hard candies." "You should avoid mouthwashes that contain alcohol." "You should include whole-grain products in your diet." "You should swallow medication with small amounts of water."

"You should suck ice chips frequently." "You should avoid mouthwashes that contain alcohol." "You should include whole-grain products in your diet." Rationale Sucralfate can cause constipation and dry mouth as adverse effects. Sucking ice chips can alleviate dry mouth. Alcohol-containing mouthwashes can increase the risk of dry mouth; the patient should avoid using them. Whole-grain products and fresh fruits can reduce the risk of constipation. Sucking hard candy can give comfort for a dry mouth. Swallowing medication with small amounts of water will not reduce the risk of constipation and dry mouth.

Which statement made by a patient indicates a need for further instruction about the use of benzocaine on a canker sore? "I will apply benzocaine before eating." "I will use saline rinses before applying benzocaine." 'It is okay to also apply aspirin on the sore to relieve pain." "Benzocaine is more effective if applied before brush my teeth."

'It is okay to also apply aspirin on the sore to relieve pain." Rationale Aspirin should not be placed on canker sores because of the high risk of severe chemical burns with necrosis. If a patient makes this statement, further teaching us needed. Benzocaine is more effective when applied before eating or performing oral hygiene. Saline rinses may be soothing and can be used before topical application of benzocaine.

A patient has been prescribed infliximab (Remicade) for the treatment of Crohn's disease. What information should the nurse include in patient teaching regarding this medication? 1. "This medication is given to suppress your immune system's overactive response." 2. "This medication has been prescribed to treat the infection in your colon." 3. "This medication is given to cure your Crohn's disease." 4. "This medication will decrease the inflammation in your intestine."

1. "This medication is given to suppress your immune system's overactive response." Rationale: Remicade is a is a biologic response modifier that is used to treat Chron's Disease because it stops the body's autoimmune response that causes the inflammation in the bowel. (p. 206)

What nursing intervention is most appropriate to decrease postoperative edema and pain in a male patient after an inguinal herniorrhaphy? 1. Applying a truss to the hernial site 2. Allowing the patient to stand to void 3. Supporting the incision during routine coughing and deep breathing 4. Elevating the scrotum with a support or small pillow

1. Applying a truss to the hernial site Rationale: Because of the location of an inguinal hernia, the best way to alleviate edema and pain is to apply an ice pack underneath the scrotum for support and the ice decreases the swelling.

A patient was admitted during the evening shift with a tentative diagnosis of cancer of the esophagus. What complaint does the nurse anticipate finding in the initial assessment of the patient? 1. Dysphagia 2. Malnutrition 3. Pain 4. Regurgitation of food

1. Dysphagia Rationale: Common symptoms of esophageal cancer include difficulty swallowing bulky foods like meat at first which progresses to difficulty swallowing softer foods as well, and a symptom called odynophagia which is painful swallowing. (p. 184)

While obtaining the patient's health history and reviewing the medical records, which information will alert the nurse that the patient has an increased risk of developing peptic ulcer disease? (Select all that apply.) 1. Excess of gastric acid or a decrease in the natural ability of the GI mucosa to protect itself from acid and pepsin 2. Invasion of the stomach and/or duodenum by Helicobacter pylori 3. Viral infection, allergies to certain foods, immunologic factors, and psychosomatic factors 4. Taking certain drugs, including corticosteroids and anti-inflammatory medications 5. Having allergies to foods containing gluten in their ingredients

1. Excess of gastric acid or a decrease in the natural ability of the GI mucosa to protect itself from acid and pepsin 2. Invasion of the stomach and/or duodenum by Helicobacter pylori 4. Taking certain drugs, including corticosteroids and anti-inflammatory medications Rationale: Those who use tobacco products, who have been exposed to Helicobacter pylori, drink excessive alcohol, have undergone physiologic trauma on the body, and who regularly use NSAIDs are at increased risk for developing peptic ulcer disease

. A patient's brother asks the nurse why the patient's pancreatic cancer is at stage IV so early after hearing the diagnosis. The nurse correctly identifies the late diagnosis and high mortality rates as being attributed to what factors? (Select all that apply.) 1. It is difficult to diagnose pancreatic cancer at an early, curable stage. 2. Patients with pancreatic cancer are often in denial. 3. The majority of cancers have metastasized at the time of diagnosis. 4. Early tumors often remain asymptomatic, or "silent," until their growth is advanced. 5. Patients often attribute the vague early symptoms of pancreatic cancer to problems that do not warrant seeking medical attention.

1. It is difficult to diagnose pancreatic cancer at an early, curable stage. 3. The majority of cancers have metastasized at the time of diagnosis. 4. Early tumors often remain asymptomatic, or "silent," until their growth is advanced. 5. Patients often attribute the vague early symptoms of pancreatic cancer to problems that do not warrant seeking medical attention. Rationale: All but number two are correct answers for as to why pancreatic cancer may be diagnosed late. Patients are not usually in denial of the cancer, it is that they are often asymptomatic and do not know about their disease.

Discharge teaching in relation to home management after a laparoscopic cholecystectomy should include which instructions? 1. Keeping the bandages on the puncture sites for 48 hours 2. Reporting any bile-colored drainage or pus from any incision 3. Using over-the-counter antiemetics if nausea and vomiting occur 4. Emptying and measuring the contents of the bile bag from the T tube every day

1. Keeping the bandages on the puncture sites for 48 hours Rationale: Before discharge, instruct the patient to immediately report severe pain, tenderness in the RUQ, increase in abdominal girth, leakage of bile-colored drainage from any puncture site, increased pulse, or low blood pressure. Patients are generally able to return to work after 3 days and can resume regular activity after a week

The student nurse is teaching a patient about his Crohn's disease. The student is correct in identifying what complication as being the result of granulomatous cobblestone lesions of the small intestine? 1. Malabsorption of nutrients 2. Severe diarrhea of 15 to 20 stools per day 3. A high probability of developing intestinal cancer 4. An inability of the body to absorb water

1. Malabsorption of nutrients Rationale: When it comes to the small intestine, malabsorption of nutrients is a big issue because this is where 80% of absorption of nutrients take place, and if there are obstructions or fissures or abscesses or fistulas or granulomatous cobblestone lesions, they can lead to problems like pernicious anemia and electrolyte imbalances with acid-base disturbances.

The surgical procedure for cancer of the pancreas involves resection of the antrum of the stomach, the gallbladder, the duodenum, and varying amounts of the pancreas. Anastomoses are constructed between the stomach, the common bile and pancreatic ducts, and the jejunum. The nurse correctly identifies this procedure with which name? 1. Whipple procedure 2. Pancreatectomy 3. Billroth I 4. Billroth II

1. Whipple procedure Rationale: The whipple procedure involves resection of the proximal pancreas, adjoining duodenum and distal portion of the stomach and the distal portion of the common bile duct.

The nurse is caring for a patient with hepatic encephalopathy. While assessing the patient, the nurse notes rapid, irregular flexion and extension (flapping) of the wrist when the nurse requests that the patient stretch out the arm and hyperextend the wrist with fingers separated. How should the nurse document this finding? 1. "Patient demonstrates the presence of varices." 2. "Patient demonstrates the presence of asterixis." 3. "Patient demonstrates the presence of pruritus." 4. "Patient demonstrates the presence of bacterial toxins."

2. "Patient demonstrates the presence of asterixis."

The student nurse asks the nurse why a patient with advanced cirrhosis has an abdomen that is so swollen. Which response by the nurse is correct? 1. "A lack of clotting factors promotes the collection of blood in the abdominal cavity." 2. "Portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space." 3. "Decreased peristalsis in the GI tract contributes to gas formation and bowel distention." 4. "Bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid."

2. "Portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space." Rationale: Hypoalbinumia and portal hypertension are complications of cirrhosis which lead to ascites, which is accumulation of fluid and albumin in the peritoneal cavity.

A patient has recently been diagnosed with celiac disease. What patient statement indicates the need for further teaching regarding the disease? (Select all that apply.) 1. "I should add pasta and bread back into my diet gradually." 2. "There is no cure for my disease, but I can manage it well with my diet." 3. "I will likely need to have surgery to repair the damage to my intestine." 4. "My children are at a higher risk for developing celiac disease because I have it." 5. "I will need to eliminate foods containing wheat flour from my diet."

2. "There is no cure for my disease, but I can manage it well with my diet." 4. "My children are at a higher risk for developing celiac disease because I have it." 5. "I will need to eliminate foods containing wheat flour from my diet." Rationale: The patient is advised to take on a gluten-free diet, not to consume wheat, rye, barley and foods containing those products. This is a genetic disorder that commonly affects the small intestine, and it is considered an autoimmune disease which has no cure. (p. 199)

A patient is scheduled for surgery for a common bile duct exploration. The nurse would expect the patient to return from surgery with which device in place? 1. An underwater-seal drainage 2. A T tube connected to gravity drainage 3. A Penrose drain 4. A nephrostomy tube

2. A T tube connected to gravity drainage Rationale: A T-tube is inserted into the common bile duct to keep the duct open and allow drainage until the edema is resolved.

The nurse is preparing a presentation on hepatitis types B and C. What should the nurse include in the presentation regarding the most common methods of becoming infected with the disease? (Select all that apply.) 1. Recent blood transfusions 2. Contaminated needles and instruments 3. Direct contact with body fluids from infected people, such as through sexual contact 4. Eating food prepared by someone with unclean hands 5. Drinking contaminated water

2. Contaminated needles and instruments 3. Direct contact with body fluids from infected people, such as through sexual contact Rationale: Contaminated needles and instruments and direct contact with body fluids from infected people along with sexual contact are the most common methods of transmitting hepatitis B and C because they involve direct exchange of bodily fluids and the bacteria into the blood stream

The nurse is assessing a newly admitted patient. Which findings are most indicative of a liver abscess? 1. Asterixis, ascites, and esophageal varices 2. Fever accompanied by chills, abdominal pain, and tenderness in the right upper quadrant 3. Enlarged spleen and spider telangiectases 4. Constipation; left quadrant abdominal cramping; and loud, high-pitched abdominal sounds on auscultation

2. Fever accompanied by chills, abdominal pain, and tenderness in the right upper quadrant Rationale: There are vague signs and symptoms of liver abscess; however, fever accompanied by chills, abdominal pain, and tenderness in the upper right quadrant are common complaints of patients. Objective data include jaundice, weight loss and weakness.

A patient is admitted with common bile duct obstruction related to cancer of the pancreas. Which clinical manifestations would the nurse expect to find? (Select all that apply.) 1. Brown feces 2. Scleral icterus 3. Dark, tea-colored urine 4. Jaundice 5. Mid-epigastric pain

2. Scleral icterus 3. Dark, tea-colored urine 4. Jaundice 5. Mid-epigastric pain Rationale: The common clinical manifestations of pancreatic cancer are complaints of anorexia, malaise, nausea, and fatigue. Other data includes change in color or stools and urine, and mid- epigastric pain referred to the back Objective data includes weight loss, jaundice and pruritis

A patient is scheduled for a hemicolectomy for removal of a cancerous tumor of the ascending colon. The patient asks the nurse why he is taking intestinal antibiotics preoperatively. Which response by the nurse is correct? 1. To decrease the bulk of colon contents 2. To reduce the bacteria content of the colon 3. To prevent pneumonia 4. To eliminate the risk of postoperative wound infection

2. To reduce the bacteria content of the colon Rationale: Taking antibiotics preoperatively for removal of a tumor in the ascending colon is a proliferative measure taken to reduce the risk of infection during the procedure, especially since the colon houses bacteria already. Antibiotics suppress the anaerobic and aerobic organisms in the colon. (p. 217)

The nurse is preparing a presentation on the differences between ulcerative colitis and Crohn's disease. What should the nurse include in the presentation? (Select all that apply.) 1. Ulcerative colitis causes more nutritional deficiencies than Crohn's disease. 2. Ulcerative colitis is confined to the mucosa and the submucosa of the colon. 3. The intestinal disease of ulcerative colitis is curable with a colectomy, whereas Crohn's disease often recurs after surgery. 4. Blood is often present in the stools with ulcerative colitis; fat is usually present in the stools with Crohn's disease. 5. Patients with ulcerative colitis may have 3 or 4 semisoft stools per day; 15 to 20 liquid stools per day are common with Crohn's disease.

2. Ulcerative colitis is confined to the mucosa and the submucosa of the colon. 3. The intestinal disease of ulcerative colitis is curable with a colectomy, whereas Crohn's disease often recurs after surgery. 4. Blood is often present in the stools with ulcerative colitis; fat is usually present in the stools with Crohn's disease. Rationale: Ulcerative Colitis is characterized as a progressive disease that begins in the anus and works up the descending colon, so it can be cured by surgery if caught early enough, whereas Chron's disease can occur sporadically in the colon and cannot always be anticipated and cured by surgery for that reason. Additionally, UC is confined to the mucosa and submucosa whereas in Chron's, the disease can affect the GI tract from the mouth to the anus. Also, the manifestations in the stool of Chron's appear as fatty stools and in UC, we typically see blood in stools. (p. 202)

A patient has been admitted with a diagnosis of peptic ulcers. Which drugs would the nurse expect this patient to be prescribed to decrease gastric acid secretion? (Select all that apply.) 1. sodium polystyrene sulfonate 2. ranitidine (Zantac) 3. erythromycin (Ery-tab) 4. sucralfate (Carafate) 5. famotidine (Pepcid)

2. ranitidine (Zantac) 5. famotidine (Pepcid)

Which grade would represent the clinical feature "oral soreness with erythema" according to the World Health Organization Oral Mucositis Scale? 0 1 3 4

4 Rationale The clinical feature "oral soreness with erythema" is considered grade 1 on the World Health Organization Oral Mucositis Scale. Grade 0 indicates that mucositis is absent. Grade 3 signifies the presence of oral ulcers; however, the patient can still tolerate a liquid diet. Grade 4 indicates that oral feeding is not possible.

The nurse is caring for a patient with cholecystitis associated with cholelithiasis. Which statement by the nurse is most accurate when answering patient questions? 1. "The disorder can be successfully treated with oral bile salts that dissolve gallstones." 2. "Analgesics are usually not necessary to relieve the pain of bile duct spasms during an acute attack." 3. "A heavy meal with a high fat content may precipitate the signs and symptoms of the disease." 4. "A low-cholesterol diet is indicated to reduce the availability of cholesterol for gallstone formation."

3. "A heavy meal with a high fat content may precipitate the signs and symptoms of the disease." Rationale: The patient that is treated conservatively must continue to avoid fatty foods, including fried foods, cream, whole milk, butter, margarine, peanut butter, chocolate, pastries, and gravies. These foods can often cause signs and symptoms of the disease to appear.

Which type of medication order should the nurse question when caring for a patient with E. coli ? 1. Antiemetics 2. Antimotility drugs 3. Antilipidemic agents 4. Beta blockers

3. Antilipidemic agents Rationale: Antimotility drugs are contraindicated for E. coli because they increase the likelihood of developing hemolytic uremic syndrome which is a pathologic condition of the kidney. (p. 197)

While caring for a patient with hepatitis A, the nurse expects the stools of the patient to appear what color? 1. Dark brown 2. Black 3. Clay-colored 4. Green

3. Clay-colored Rationale: It is common for patients with Hepatitis A to have clay-colored stools and tea-colored urine because of the disease process and how it affects the organs.

While discharging a patient after a laparoscopic cholecystectomy, the nurse hears the patient report mild shoulder pain. The nurse is aware that the pain is likely caused by which factor? 1. Paralytic ileus with mesenteric irritation 2. Incision along the rectus abdominis muscle 3. Diaphragmatic irritation secondary to residual carbon dioxide 4. Spasm of the duct of Wirsung

3. Diaphragmatic irritation secondary to residual carbon dioxide Rationale: Mild shoulder pain following a laparoscopic cholecystectomy is common after this procedure and usually subsides after 24 hours, and it is indicative of gas built up or having to burp a lot at first.

During assessment of a patient with esophageal achalasia, what does the nurse expect the patient to report when the health history is obtained? 1. A history of alcohol use 2. A sore throat and hoarseness 3. Dysphagia, especially with liquids 4. Relief of pyrosis with the use of antacids

3. Dysphagia, especially with liquids Rationale: The primary symptom of achalasia is dysphagia, which is difficulty swallowing. Often the patient will experience a feeling of food sticking to the lower part of the esophagus and it may progress to regurgitation of food and eventually substernal chest pain. (p. 186)

The nurse is caring for a patient scheduled for an esophagogastroduodenoscopy. Which intervention should the nurse include in the patient's plan of care? (Select all that apply.) 1. Allow the patient to drink fluids up to 4 hours before the examination. 2. Withhold any anticholinergic medications before the procedure. 3. Encourage the patient to not smoke before the examination. 4. Maintain NPO status until the gag reflex returns postprocedure. 5. Instruct the patient to contact the health care provider if intense abdominal pain occurs postprocedure.

3. Encourage the patient to not smoke before the examination. 4. Maintain NPO status until the gag reflex returns postprocedure. 5. Instruct the patient to contact the health care provider if intense abdominal pain occurs postprocedure. Rationale: Prior to and EGD exam, it is routine for a patient to be NPO after midnight the night before the procedure, patient is sedated after signing informed consent and the pharynx is anesthetized. Post-procedure, the patient is to be NPO until the gag reflex returns after checking with a tongue blade. Other post-operative interventions include monitoring vital signs, assessing s/s of perforation, assessing abdominal pain and tenderness, and assessing oral bleeding and melena. (p. 177)

A patient has advanced cirrhosis of the liver with an acute exacerbation of hepatic encephalopathy. What type of food may be limited in his diet? 1. Fruits 2. Vegetables 3. Meats 4. Carbohydrates

3. Meats Rationale: A protein-restrictive diet is thought to reduce the amount of ammonia in the intestine, thus preventing encephalopathy since encephalopathy is a type of brain damage caused by liver disease and subsequent ammonia intoxication

When caring for a patient admitted with a bleeding peptic ulcer, the nurse will include what intervention in the patient's acute plan of care? 1. Measuring the blood pressure and pulse rates each shift 2. Frequently monitoring arterial blood levels 3. Observing vomitus for color, consistency, and volume 4. Checking the patient's stools for occult blood

3. Observing vomitus for color, consistency, and volume Rationale: Noting the color, consistency and amount of vomitus tells a nurse whether there is active bleeding, how much bleeding and whether there could be hemorrhaging going on. If the color is bright red, it indicates active bleeding whereas tarry, black vomitus can indicate occult blood which is not good because there is gastric acid reacting with the hemoglobin. (p. 188)

A patient has been admitted with right upper quadrant pain and has been placed on a low-fat diet. Which tray would be acceptable for the patient? 1. Whole milk, veal, rice, and pastry 2. Liver, fried potatoes, gelatin, and avocado 3. Skim milk, lean fish, steamed carrots, and fruit 4. Ham, mashed potatoes, creamed peas, and gelatin

3. Skim milk, lean fish, steamed carrots, and fruit Rationale: Skim milk, lean fish, steamed carrots and fruit have the lowest amount of fat between the options, even though milk is a dairy product and fish is protein they are much lower in the overall fat content than the other trays, thus making number 3 the best option.

The nurse is teaching a postgastrectomy patient about dumping syndrome. Which statement indicates that the patient needs further instruction? 1. "I will lie down after eating a meal." 2. "I will eat smaller portions of food, more frequently." 3. "I will not drink liquids when I eat." 4. "I will avoid fats and increase carbohydrates."

4. "I will avoid fats and increase carbohydrates." Rationale: Following a gastrectomy, patients are taught to eat six small meals daily that are high in protein and fat and low in carbohydrates, they are told to eat slowly, and to avoid drinking anything during meals. (p. 196)

After a transverse loop colostomy, the nurse inspects the patient's stoma. The stoma appears pale pink with some dusky discoloration at the lower border. What is the most appropriate action by the nurse? 1. Clean the area around the stoma and record the observation in the nurses' notes. 2. Carefully place a clean pouch over the stoma to prevent any tissue damage. 3. Cover the stoma with petroleum gauze to prevent any further irritation to the stoma. 4. Clean the area around the stoma, apply a clean pouch, and notify the health care provider about the discoloration.

4. Clean the area around the stoma, apply a clean pouch, and notify the health care provider about the discoloration. Rationale: The nurse still needs to cover and protect the stoma after cleaning it, but the pale color could be indicative of poor tissue perfusion and/ or low hemoglobin and hematocrit, which is cause to notify the prescriber before a more grave issue like infection and tissue death occurs.

A patient has undergone numerous diagnostic tests to determine whether a gastric malignancy is present. The patient asks the nurse what test will be most definitive for diagnosis. Which response by the nurse is correct? 1. Radiographic GI series 2. Breath test for H. pylori 3. Serum test for H. pylori antibodies 4. Endoscopy with biopsy

4. Endoscopy with biopsy Rationale: An endoscopy visualizes the esophagus, stomach and duodenum and is used for routine screenings as well as for the detection of tumors, lesions and other abnormalities of the linings of the mucosa. If an abnormality is found, through an endoscopy a biopsy can be taken to be sent to the lab for examination to get results faster and more efficiently than other examinations. (p. 176)

If a patient is scheduled for an ultrasound of the pancreas, which situation would cause the examination to be postponed? (Select all that apply.) 1. Low serum albumin 2. MRI of abdomen 3. ERCP examination 4. Recent barium enema examination

4. Recent barium enema examination Rationale: Gas and barium may interfere with soundwave transmission, so the exam should be postponed to get accurate results

The nurse is caring for a postoperative cholecystectomy patient. The nurse includes coughing and deep breathing in the patient's care plan based on what criteria? 1. The patient is often obese. 2. The patient usually smokes. 3. The patient is on bed rest for a prolonged period. 4. The patient tends to take shallow breaths due to the location of the incision.

4. The patient tends to take shallow breaths due to the location of the incision. Rationale: The patient needs encouragement to use the incentive spirometer to cough and deep breathe after this procedure because of intense discomfort or pain due to the incision site being close to where the lungs tend to expand. The nurse may offer a prescribed analgesic before these exercises.

When caring for a patient with acute exacerbation of hepatic encephalopathy, the nurse may give a lactulose enema, provide a low-protein diet, and limit physical activity. The nurse explains to the patient that these measures are taken for what reason? 1. To promote fluid loss 2. To eliminate potassium ions 3. To decrease portal pressure 4. To decrease ammonia production

4. To decrease ammonia production Rationale: In hepatic encephalopathy, this diet is necessary to decrease ammonia production which the lactulose will flush out of the body

The nurse is discharging a patient after a hemorrhoidectomy. Which teaching point should the nurse include in the discharge instructions? 1. Do not use the Valsalva maneuver. 2. Eat a low-fiber diet to rest the colon. 3. Administer an oil-retention enema to empty the colon. 4. Use a prescribed analgesic before a bowel movement.

4. Use a prescribed analgesic before a bowel movement. Rationale: Because the patient may be facing a large amount of anxiety going into the first stool following this surgery, the nurse should administer an analgesic to reduce pain and discomfort and encourage the patient to pass the stool as they usually would. (p. 219)

What is halitosis? A foul mouth odor The small, red papules that develop into fluid-filled vesicles Painful inflammation of the mucous membranes of the mouth The whitish-yellow substance that builds up on teeth and gum lines around the teeth

A foul mouth odor Rationale Halitosis can be described as a very foul mouth odor. Small, red papules that develop into fluid-filled vesicles may appear in cases of cold sores. Mucositis is described as the painful inflammation of the mucous membrane of the mouth. Plaque is the whitish-yellow substance that builds up on the teeth and the gum lines around the teeth.

Which patient has a greater chance of developing Barrett 's esophagus (esophageal metaplasia )? A patient with untreated gastroesophageal reflux disease (GERD) A patient with worsening symptoms of achalasia A patient with gastritis experiencing gastrointestinal bleeding A patient with scarring and inflammation associated with peptic ulcer disease

A patient with untreated gastroesophageal reflux disease (GERD) Rationale If GERD is left untreated ,serious ( precancerous)in the esophageal lining may develop .This condition is known as Barrett 's esophagus ( esophageal metaplasia ). Dysphagia is a symptom of achalasia ,and the patient may have decreased motility and dilation of the lower portion of the esophagus .If dysphagia worsens ,little or no food can enter the stomach .A patient may have gastrointestinal bleeding as a result of hemorrhagic gastritis .Scarring and inflammation will cause gastric outlet obstruction in the patient .

A nurse who is providing education to a patient newly diagnosed with liver cirrhosis discusses appropriate pain control at home. Which over-the-counter medication listed by the patient indicates a need for further education on appropriate pain medication choices? Aspirin (Ecotrin) Ibuprofen (Advil) Naproxen (Aleve) Acetaminophen (Tylenol)

Acetaminophen (Tylenol) Rationale Acetaminophen (Tylenol) is hepatotoxic and should not be used in a patient with liver disease. Aspirin, ibuprofen, and naproxen should all be used with caution in a patient with liver disease.

patient diagnosed with alcoholic cirrhosis of the liver. Which item written on the nursing Kardex would the licensed practical/vocational nurse (LPN/LVN) ask the registered nurse (RN) about before implementing? Folic acid supplement Acetaminophen prn pain Diphenhydramine prn itching High-calorie, low-fat, low-sodium diet

Acetaminophen prn pain Rationale Acetaminophen (Tylenol) is a known hepatotoxin and would be inappropriate and dangerous for this patient. A high-calorie, low-fat, low-sodium diet is appropriate. Also, a moderate high-protein diet would be encouraged as well, as long as liver failure is not imminent. Diphenhydramine (Benadryl) is safe to administer to the patient with hepatic cirrhosis. A folic acid supplement will help to improve nutritional deficiencies in the patient with hepatic cirrhosis. Vitamins may be administered as well.

Which condition does the nurse suspect in an adult patient whose aspartate aminotransferase (AST) level is 45 units/L? Hyperparathyroidism Cancer of the pancreas Acute hemolytic anemia Metastatic tumor in the bones

Acute hemolytic anemia Rationale AST is a liver enzyme whose normal range in adults is 0 to 35 units/L. In this patient, the AST level iS 45 units/L. An increase in AST levels indicates acute hemolytic anemia. Hyperparathyroidism can be suspected if the patient has elevated levels of alkaline phosphatase. Cancer of the pancreas can be suspected if the patient has elevated levels of gamma-glutamyl transpeptidase (GGT). Metastatic tumor in bones is suspected if the patient has elevated levels of alkaline phosphatase.

Which condition is associated with dumping syndrome ? Acute gastritis Gastric carcinoma Gastroesophageal reflux disease (GERD) After gastric resection or peptic ulcer surgery

After gastric resection or peptic ulcer surgery Rationale Dumping syndrome is a disorder that can ofcur after gastric resection procedures .It occurs in approximately one -half to one -third of patients who have undergone peptic ulcer surgery .It is a rapid gastric emptying ,causing distention of the duodenum or jejunum ,and is produced by a bolus of hypertonic food .Dumping syndrome is not associated with acute gastritis .Clinical manifestations of this disorder include fever ,epigastric pain ,nausea ,vomiting ,headache ,coating of the tongue ,and loss of appetite .Dumping syndrome is not associated with GERD .Clinical manifestations of this disorder primarily include heartburn ,although in severe cases ,it may produce dysphagia or odynophagia .Dumping syndrome is not associated with gastric carcinoma .This patient may be asymptomatic in the early stages ;in later stages ,the patient may develop pallor ,lethargy ,and weight loss .

Which is the proper method for administration of amlexanox (Aphthasol)? Select all that apply. After meals Four times a day Before oral hygiene On the canker sores Surrounding the canker sore

After meals Four times a day On the canker sores Rationale The patient should apply amlexanox (Aphthasol) after meals. The patient should apply amlexanox (Aphthasol) four times a day directly on the canker sores, not on the surrounding area, for effective results. The patient should apply amlexanox (Aphthasol) after oral hygiene for effective results.

Which products should a patient with mucous membrane irritation avoid? Select all that apply. Alcohol Tobacco Dairy products Hot and spicy foods Gravies or sauces to moisten food

Alcohol Tobacco Hot and spicy foods Gravies or sauces to moisten food Rationale The most important advice for a patient with irritation in the mucous membranes is to avoid alcohol, tobacco, and hot and spicy foods because these products will increase irritation. A patient with any oral problem such as irritation in the mucous membranes should consume bland foods such as dairy products, fruit juices, and vegetable juices. Patients who have irritation of the mucous membranes should also avoid using gravies and sauces.

prescribes pancrelipase (Pancrease) to a patient with pancreatic insufficiency. Which factor does the nurse assess before administering the drug? Severity of skin integrity Electrolytes in the patient Renal function and urinary output Allergy to pork

Allergy to pork Rationale Pancrelipase (Pancrease) is a drug derived from pork; the nurse should, therefore, check whether the patient is allergic to pork. Skin integrity severity is assessed when the patient is administered cholestyramine (Questran). Electrolytes and serum creatinine levels have to be assessed in the patient after administration of spironolactone (Aldactone). Renal function is monitored after administration of neomycin (Mycifradin) and the urinary output is monitored after administration of vasopressin (Pitressin).

Which of the following medications would be most effective in treating duodenal ulceration caused by Helicobacter pylori ? Aluminum hydroxide with magnesium hydroxide (Maalox) Amoxicillin Ranitidine (Zantac) Omeprazole (Prilosec)

Amoxicillin Rationale H .pylori, one of the causes of duodenal ulcerations, is a spiral-shaped bacterium. If this is determined to be such as amoxicillin. Ranitidine ( Zantac)is a histamine -2(H2)receptor-blocking agent that decreases acid secretion by blocking H 2 receptors . Although ranitidine is used in the treatment of duodenal ulcers,if the cause is determined to be H .pylori, this would not be the best choice . Aluminum hydroxide with magnesium ( Maalox)is an antacid that works by neutralizing or reducing the acidity of stomach contents. If the cause is determined to be H .pylori, Maalox would not be the best choice as it neutralizes or reduces the acidity of the stomach contents and would not be used for the bacteria . Omeprazole (Prilosec)is a proton pump inhibitor that works by inhibiting the secretion of gastrin by the parietal cells of the stomach. If the cause is determined to be H .pylori ,omeprazole would not be the absolute best choice to treat the ulceration .

Which hematologic symptoms might be noted in a patient with cirrhosis of the liver? Select all that apply. Anemia Leukemia Leukopenia Polycythemia vera Thrombocytopenia

Anemia Leukopenia Thrombocytopenia Rationale Hematologic problems include thrombocytopenia, leukopenia, anemia, and coagulation disorders. Anemia caused by inadequate red blood cell (RBC) production and survival, poor diet, poor absorption of folic acid, and bleeding from varices. Anemia, leukopenia, and thrombocytopenia are also probably caused by the splenomegaly that results from the backup of blood from the portal vein into the spleen (portal hypertension). Overactivity of the enlarged spleen, results in increased removal of blood cells from circulation. Leukemia and polycythemia vera are not caused by cirrhosis.

A patient complains of soreness in the mouth and difficulty swallowing food . Which objective sign in this patient will indicate oral candidiasis? Leukoplakia Hoarseness Loss of weight Angular cheilitis

Angular cheilitis Rationale Soreness in the mouth and difficulty swallowing food are subjective signs of oral candidiasis .In this patient ,the nurse may find objective signs ,such as angular cheilitis cracks at the corners of the mouth )and eating .Leukokla is a white ,firmly attached patch on the mouth or tongue mucosa ,which is a manifestation of oropharyngeal cancer .Hoarseness is seen in a patient wath gastroesophageal reflux disease .A patient with carcinoma of the digestive tract shows such symptoms as weight loss .

Which classes of drugs are used to reduce the symptoms of peptic ulcers ?Select all that apply . Steroids Antacids Mucosal healing agent Proton pump inhibitors PPIs) Histamine -2(H2) creceptor blockers

Antacids Mucosal healing agent Proton pump inhibitors PPIs) Histamine -2(H2) receptor blockers Rationale Antacids acids are used in patients with peptic ulcers to reduce the acidity of stomach contents .Mucosal healing agents accelerate the healing process for ulcers by forming an ulcer -adherent complex that covers the ulcer and protects it from erosion by pepsin , anid ,and bile salts .Proton pump inhibitors inhibit secretion of gastrin by the parietal cells of the stomach .H 2receptor blockers decrease acid secretions by blocking H 2receptors .Steroids are used to treat extensive inflammation of the intestinal lining in patients with celiac disease .

In addition to a proton pump inhibitor, the nurse anticipates the healthcare provider will prescribe another medication from which drug class to eradicate the Helicobacter pylori in a patient being treated for gastritis? Antibiotic Antiinflammatory Prostaglandin inhibitor Therapeutic nutrients

Antibiotic So close! Rationale Antibiotics may be prescribed in addition to proton pump inhibitors to eradicate Helicobacter pylori. Helicobacter pylori would not be eradicated by antiinflammatories, prostaglandin inhibitors, or therapeutic nutrients.

Which type of medication should the nurse question if prescribed for a patient with xerostomia? Anticholinergic Antitussive Antibiotic Anticoagulant

Anticholinergic Rationale Anticholinergic medications may cause xerostomia because their adverse effects include dryness. Antitussive, antibiotic, and anticoagulant medications may be given to a patient who has xerostomia.

Which type of medication should the nurse question if prescribed for a patient with xerostomia? Anticholinergic Antitussive Antibiotic Anticoagulant

Which is a possible cause of a secondary bacterial infection for a patient with cold sores? Administration of aspirin Administration of naproxen (Aleve) Application of neomycin/polymyxin B/bacitracin (Neosporin) Application of zinc sulfate (Pedtrace-4)

Application of zinc sulfate (Pedtrace-4) Rationale Cold sores should be kept moist to prevent drying and cracking because cracking increases the risk of secondary bacterial infection. Healthcare providers should not use zinc sulfate (Pedtrace-4) because this medication can cause drying and cracking of the cold sores. Aspirin and naproxen (Aleve) provide pain relief for patients with cold sores. Neomycin/polymyxin B/bacitracin (Neosporin) is effective in treating secondary infections in a patient with cold sores.

Which advice from the healthcare provider would be most effective for healing the patient's cold sores? Apply docosanol (Abreva). Administer ibuprofen (Advil). Apply zilactin B (Benzocaine 10%). Administer acetaminophen (Tylenol).

Apply docosanol (Abreva). Rationale In patients with cold sores, docosanol (Abreva) shortens healing time and duration of symptoms such as tingling, pain, burning, and itching. This medication should be provided daily for effective results. Ibuprofen (Advil) is an oral analgesic that provides temporary pain relief, but will not heal the cold sores. Zilactin B (Benzocaine 10%) is a protectant, which provides temporary relief from the pain and itching and prevents drying of the lesions; this medication is not effective in healing cold sores. Acetaminophen (Tylenol) is also an oral analgesic, which provides pain relief but will not heal cold sores.

Which premedication assessment should the nurse perform in a patient taking digoxin (Lanoxin) who has also prescribed esomeprazole (Nexium)? Assess serum thyroxin levels. Assess the blood platelet count. Assess the white blood cell count. Assess serum magnesium levels.

Assess serum magnesium levels. Rationale Long-term use of esomeprazole (Nexium) and digoxin (Lanoxin) can induce hypomagnesemia; therefore the nurse should assess the patient's serum magnesium levels before administration of esomeprazole to ensure safety. Long-term use of esomeprazole does not reduce the serum thyroxin levels, blood platelet counts, or white blood cell counts.

A nurse is caring for a patient who underwent laparoscopic cholecystectomy 8 hours ago. The patient requests for help to get up and go the bathroom. Which nursing action is most therapeutic for the patient? Assist the patient to the bathroom. Obtain an order for a Foley catheter. Encourage the use of the bedside commode. Remind the patient that he or she is on complete bed rest, and offer a bedpan.

Assist the patient to the bathroom. Rationale Patients should ambulate by the first night postoperatively; therefore, the nurse should assist the patient to the bathroom. The patient is not on bed rest, so a bedpan is not necessary. A Foley catheter is not recommended for this patient. The patient should use a bedside commode if unable to ambulate safely to the bathroom

Which instruction should be given to a patient for the use of viscous lidocaine 2%? Mix the medication with juice. Administer the medication twice daily. Use a mouthwash before administering the medication. Avoid eating for 30 minutes after taking the medication.

Avoid eating for 30 minutes after taking the medication. Rationale The patient should avoid eating or drinking for at least 30 minutes after the use of viscous lidocaine because of the absence of the gag reflex and potential risk for aspiration. Viscous lidocaine is not mixed with juice and is administered frequently. Mouthwashes are not used before administering viscous lidocaine 2%.

Which instruction does the nurse include when teaching a patient how to use chlorhexidine for treatment of mucositis? Swallow chlorhexidine after its use. Smoking should be avoided for at least 10 minutes after administering. Avoid eating for at least 30 minutes after use to prevent systemic toxicity. Chlorhexidine can be used to replace normal oral hygiene after treatment of mucositis.

Avoid eating for at least 30 minutes after use to prevent systemic toxicity. Rationale Patients should avoid drinking and eating for at least 30 minutes after using chlorhexidine. Chlorhexidine should not be swallowed, as prolonged swallowing of mouthwashes may lead to systemic toxicities. Smoking should be avoided for at least 30 minutes after taking chlorhexidine. After oral mucositis has been treated, chlorhexidine should not be used to replace normal oral hygiene.

A nurse is teaching an obese patient with gastroesophageal reflux disease (GERD) measures that should be taken to prevent complications .Which instructions would the nurse give ? Select all that apply . Avoid tea and coffee . Maintain a low -fat diet . Avoid smoking cigarettes . Use anticholinergic drugs ,as prescribed . Lie down immediately after having food .

Avoid tea and coffee . Maintain a low -fat diet . Avoid smoking cigarettes .

Which complication is a patient with cirrhosis at risk for? Falls Bleeding Pneumonia Myocardial infarction

Bleeding Rationale Cirrhosis would make the patient unable to absorb vitamin K, which is an important component of the clotting cascade; a deficiency in vitamin K increases the risk of bleeding. The patient's risk of falls, pneumonia, and myocardial infarction are not increased as a result of decreased vitamin K.

he nurse is caring for a patient who has had a partial gastrectomy. Which vitamin will the nurse anticipate educating the patient about? 1. A 2. B12 3. C 4. K

B12 Rationale Rationale: Pernicious anemia can be a serious complication following a partial or total gastrectomy because of the loss of the intrinsic factor which is only produced in the stomach which aids in the absorption of Vitamin B12. Therefore, since pernicious anemia can be caused by a gastrectomy, vitamin K is the vitamin that should be taught to the patient about. (p.196)

Jaundice is caused by an excess amount of which component in the bloodstream? Bilirubin Alkaline phosphatase Lactic dehydrogenase (LDH) Aspartate aminotransferase (AST)

Bilirubin Rationale Jaundice causes yellow discoloration of body tissues because of an excess amount of bilirubin in the bloodstream. This abnormal assessment finding is recognized when total serum bilirubin exceeds 2.5 mg/dL. AST is elevated in myocardial infarction, hepatitis, liver disorders (cirrhosis, necrosis, tumor, hepatitis), acute pancreatitis, and hemolytic anemia; it does not result in jaundice. Alkaline phosphatase is elevated in biliary tract disorders, hepatic tumors, cirrhosis, primary and metastatic tumors, hyperparathyroidism, and bone disorders (fractures, tumors); it does not result in jaundice. Lactic dehydrogenase is elevated in myocardial infarction, pulmonary infarction, hepatic disease, pancreatitis, and skeletal muscle disease; it does not result in jaundice.

Which medications might be beneficial for a patient who has heartburn and stomach distention resulting from hyperacidity? Select all that apply. Ranitidine Sucralfate Bismuth Simethicone Metoclopramide

Bismuth Simethicone Rationale Bismuth and simethicone are used to treat heartburn and stomach distention by acting as defoaming agents and breaking up gas bubbles in the stomach. Ranitidine is used to treat gastroesophageal reflux disease, duodenal ulcers, and pathologic hypersecretory conditions. Sucralfate is used to treat duodenal ulcers, particularly in those patients who do not tolerate other forms of therapy. Metoclopramide is used to relieve the symptoms of gastric reflux esophagitis and diabetic gastroparesis.

A patient with a positive breath test result has been diagnosed with Helicobacter pylori ( H.pylori ) pepticulcer disease .The nurse anticipates administering which drugs ? Select all that apply . Bismuth Acyclovir (Zovirax) Tetracycline (Tetra-ABC) Amphotericin (Amphotec) Metronidazole (Flagyl)

Bismuth Tetracycline (Tetra-ABC) Metronidazole (Flagyl)

Which substances in a patient 's stool indicate an abnormality ?Select all that apply . Blood Mucus Excess fat Bile pigment Dead bacteria

Blood Mucus Excess fat Rationale The presence of blood and mucus in the stool is an abnormal finding and is associated with internal bleeding ,infection ,and inflammation .The presence of excess fat is an abnormal finding and indicates liver dysfunction .Bile pigment and dead bacteria are normal constituents of fecal matter .

A patient has been diagnosed with diverticulosis as a result of muscle thickening and increased intracolonic pressure .Which recommendation would the nurse give the patient with regard to food choices ? Clear liquid diet Low -residue diet Limited fluid intake Bran ,fruits ,and vegetables

Bran ,fruits ,and vegetables Rationale When muscle thickening and increased intracolonic pressure are the causes of diverticulosis ,a high -fibercdiet of bran ,fruits ,and vegetables is recommended .Also ,sulfa drugs and analgesics may be used in treating the disease .A clear liquid diet would not be helpful in treating diverticulosis as a result of muscle thickening and increased increased intracolonic pressure but might be used in a diverticulitis .A low -residuecdiet would not be helpful in treating diverticulosis as a result of muscle thickening and increased intracolonic pressure ;it would be appropriate ,however ,if muscle atrophy was the cause of the disease .Limited fluid intake would be inappropriate for this disorder and would not be helpful .

Which color of mouthwash is effective for medicinal use? Red Green White Brown

Brown Rationale Brown mouthwash is effective for medicinal use. Red mouthwash indicates a spicy flavor, green mouthwash indicates a minty flavor, and white mouthwash is effective for whitening.

Which antiulcer medication may cause rebound hyperacidity? Cimetidine (Tagamet) Omeprazole (Prilosec) Misoprostol (Cytotec) Calcium carbonate (Dicarbosil)

Calcium carbonate (Dicarbosil) Rationale Calcium carbonate (Dicarbosil) may cause rebound hyperacidity. Omeprazole (Prilosec) may cause rashes and hypomagnesemia. Cimetidine (Tagamet) may cause gynecomastia and hepatotoxicity. Misoprostol (Cytotec) may cause diarrhea.

Which mouth disorder is known as "the disease of the diseased"? Mucositis Cold sores Candidiasis Canker sores

Candidiasis Rationale Candidiasis is a fungal infection caused by Candida albicans. It is known as "the disease of the diseased" because it appears in debilitated patients taking a variety of medicines. Mucositis is a painful inflammation of the mucous membranes of the mouth. Cold sores are caused by the herpes simplex type 1 virus (herpes simplex labialis). Canker sores may occur as a result of stress and local trauma.

On examining a patient 's mouth ,a nurse notes white curd like lesions surrounded by erythematous mucosa .Which condition should the nurse suspect ? Cheilitis Glossitis Candidiasis Leukoplakia

Candidiasis Rationale Candidiasis manifests as white curd like lesions that are surrounded by erythematous lesions in the mouth .Cheilitis is inflammation of the lips with fissuring ,scaling ,and crusting .Glossitis manifests as a reddened ,ulcerated ,swollen tongue .Leukokla refers to the presence of thick white patches on the tongue .

The nurse anticipates a patient with achalasia will undergo which surgical procedure ? Gastrostomy Cardiomyotomy Esophagectomy Esophagogastrectomy

Cardiomyotomy

A patient comes to the clinic reporting intestinal cramping ,diarrhea ,and bloating after ingesting foods ,such as pasta and pizza .However ,meals consisting of meat ,vegetables ,and a potato do not cause these symptoms .The nurse anticipates the patient may be diagnosed with which disease ? Celiac disease Ulcerative colitis Irritable bowel syndrome Inflammatory bowel disease

Celiac disease Rationale Celiac disease is characterized by intestinal disturbances caused by the ingestion of gluten .The patient would notice a difference in symptoms betweel which gluten is ingested ( pasta,pizza ),and when it is not ( meat,vegetables ,potato ). Ulcerative colitis ,irritable bowel syndrome ,and inflammatory bowel disease are not dependent on the ingestion of gluten .

Which intervention may help decrease the unpleasant chalky taste associated with taking an antacid tablet? Take half the dose of medication. Change the brand and flavor of the medication. Take the tablets along with antacid oral solution. Report to the healthcare provider immediately.

Change the brand and flavor of the medication. Rationale Antacids may have an unpleasant chalky taste; changing the brand or flavor may reduce the patient's discomfort. Taking half the dose of medication can result in drug insufficiency. Taking tablet and liquid dosage forms of antacids simultaneously can result in drug toxicity. The healthcare provider does not need to be notified because the situation is not urgent.

Which treatments may trigger cold sores? Select all that apply. Chemotherapy Anticholinergics Local anesthetics Radiation therapy Topical analgesics

Chemotherapy Radiation therapy Rationale Cold sores are caused by the herpes simplex type 1 virus. This disorder most commonly occurs at the junction of the mucous membrane and the skin of the lips or nostrils. Chemotherapy and radiation therapy depress the immune system and triggers cold sores. Xerostomia may be triggered by anticholinergic agents. Local anesthetics can temporarily relieve the pain and itching associated with cold sores. Topical analgesics may temporarily reduce the pain of cold sores.

Which mouthwash would be most effective for a patient who underwent radiation therapy? Antiseptic mouthwash (Listerine) Lidocaine viscous 2% Chlorhexidine (Peridex) A 0.9% solution of sodium chloride

Chlorhexidine (Peridex) Rationale A patient who underwent radiation therapy is more susceptible to mucositis. Therefore the patient should use chlorhexidine (Peridex). Listerine is effective for reducing plaque. Lidocaine viscous 2% is given to patients with sore throats or mouth ulcers. A 0.9% solution of sodium chloride provides temporary, soothing relief of pharyngeal irritation in the nasogastric and endotracheal tubes. This solution also helps patients with a sore throat or patients who have undergone oral surgery.

A patient arrives in the emergency department complaining of severe abdominal pain in the right upper quadrant that began 2 hours ago, immediately after a large meal of fatty food. Which diagnosis does the nurse anticipate? Hepatitis Pancreatitis Cholecystitis Irritable bowel disease

Cholecystitis Rationale Sudden onset upper quadrant abdominal pain after a fatty meal is most likely cholecystitis caused by cholelithiasis. This patient is not likely to have hepatitis, pancreatitis, or irritable bowel syndrome.

Which drug does the nurse expect the health care provider to prescribe to a patient with acute pancreatitis to prevent stress ulcers? Ribavirin (Rebetol) Propranolol (Inderal) Cimetidine (Tagamet) Propantheline (Pro-Banthine)

Cimetidine (Tagamet) Rationale The patient with pancreatitis has reduced gastric pH, which may result in stress ulcers. To prevent this condition, the health care provider should prescribe an antacid to elevate the gastric pH. Antacids, such as cimetidine (Tagamet), are expected to be prescribed. Ribavirin (Rebetol) is used in the treatment of chronic hepatitis C infections. Propranolol (Inderal) reduces the risk of bleeding from nonbleeding esophageal varices. Propantheline (Pro-Banthine) helps decrease pancreatic activity in patients with pancreatitis.

Which medication may cause breast soreness and gynecomastia? Cimetidine (Tagamet) Misoprostol (Cytotec) Lansoprazole (Prevacid) Metoclopramide (Reglan)

Cimetidine (Tagamet) Rationale Cimetidine (Tagamet) is an histamine-2 (H 2) blocker that may cause chest soreness and gynecomastia. Misoprostol (Cytotec) may cause miscarriage and is contraindicated during pregnancy. Lansoprazole (Prevacid) may cause hypomagnesemia or increase the risk of fractures. Metoclopramide (Reglan) may cause extrapyramidal symptoms.

Which instruction does the nurse include in a patient's teaching plan for the use of clotrimazole lozenges? Take the medication on an empty stomach. Do not eat or drink for at least 30 minutes after taking. Rinse the mouth thoroughly with water after taking the medication. Cleanse the mouth with the prescribed solution before taking the medication.

Cleanse the mouth with the prescribed solution before taking the medication. Rationale Before administering topical agents for oral fungal infections, the mouth should be cleansed to improve the contact of the medication with the denuded surface. After taking the medication, the patient should not have food or drink for at least 15 minutes. There is no need to take the medication on an empty stomach because its action is local in the mouth.

Which class of medication would the nurse recognize as most beneficial to a patient with ulcer craters on the gastric mucosa? Antacids Coating agents Prokinetic agents Proton pump inhibitors

Coating agents Rationale Ulcer craters are characteristic features that occur on the lining of the stomach wall. Coating agents provide a protective barrier around the mucosal lining and prevent hydrochloric acid from coming into contact with the craters. Antacids are prescribed for hyperacidity associated with GERD, gastritis, and hiatal hernia. Prokinetic agents are used to treating Zollinger-Ellison syndrome. Proton pump inhibitors are administered to control acid reflux and GERD.

Which disorder does the nurse suspect in an elderly patient with a history of diverticulosis who reports rectal bleeding ? Infection Colon cancer Irritable bowel syndrome Inflammatory bowel disease

Colon cancer Rationale Rectal bleeding is the most common warning sign of colon cancer ,and the nurse should evaluate the patient for this condition .Additional factors this patient has for colon cancer are age and history of diverticulitis .Infections are usually present with diarrhea ,which may contain blood .Irritable bowel syndrome and inflammatory bowel disorders are associated with abdominal pain .In irritable bowel syndrome ,rectal bleeding does not occur .

Which instruction by the nurse is accurate to give a patient taking rabeprazole who experiences headaches and fatigue? Take the medication after meals. Crush the drug before taking it. Stop using the medication immediately with a headache. Consult the healthcare provider if the proton pump inhibitor causes headache or fatigue.

Consult the healthcare provider if the proton pump inhibitor causes headache or fatigue. Rationale Proton pump inhibitors such as rabeprazole may cause headache and fatigue. The nurse would encourage the patient to consult the prescribing healthcare provider about these effects. The patient should take rabeprazole 30 minutes before the first meal of the day and they should be kept whole to ensure effective absorption. Crushing the tablets can result in decreased drug absorption. A licensed practical nurse is not authorized to instruct the patient to stop taking medication.

Which drug would the nurse expect the health care provider to prescribe before initiating a liver transplantation to ensure a safe and successful surgery? Cyclosporine (Gengraf) Acetaminophen (Tylenol) Dimenhydrinate (Dramamine) Hydroxyzine pamoate (Vistaril)

Cyclosporine (Gengraf) Rationale The most common complications in the recipient of a liver transplant include rejection of the new liver tissue and infection. The use of cyclosporine (Gengraf), an effective immunosuppressant drug, has been a major factor in improving the success rate of liver transplantation. Cyclosporine (Gengraf) does not cause bone marrow suppression and does not impede wound healing. Acetaminophen (Tylenol) is used to relieve pain and reduce fever in the patient. Dimenhydrinate (Dramamine) is an antiemetic drug given to patients with severe liver dysfunction. Hydroxyzine pamoate (Vistaril) is also an antiemetic; however, it is contraindicated in patients with liver dysfunction.

The nurse anticipates administering which medication to a patient immediately after liver transplantation? Lactulose (Enulose) Cyclosporine (Sandimmune) Acetaminophen (Tylenol) Hepatitis B vaccine

Cyclosporine (Sandimmune) Rationale Immediately after transplantation, the nurse should anticipate administering cyclosporine to help prevent transplant rejection. Acetaminophen is hepatotoxic and should not be administered after liver transplantation. Lactulose and hepatitis B vaccine are not necessary at this point.

Which medicine predisposes a patient to candidiasis by depressing defense mechanisms? Cytotoxics Anticholinergics Antipsychotics Antihypertensives

Cytotoxics Rationale Cytotoxics predispose a patient to candidiasis by depressing defense mechanisms. Anticholinergics, antipsychotics, and antihypertensives also predispose a patient to candidiasis but do not depress defense mechanisms. These drugs cause xerostomia.

When the nurse is interviewing a patient about his health history ,which conditions should the nurse include as relevant to the gastrointestinal ( GI)system ? Select all that apply . Hemorrhoids Nasal polyps Monthly income Lactose intolerance Nausea and vomiting Abdominal distension

Hemorrhoids Lactose intolerance Nausea and vomiting Abdominal distension

Which laboratory finding correlates with Q-T interval prolongation in a patient taking lansoprazole? Decreased calcium level Decreased thyroxin level Decreased magnesium level Decreased red blood cell level

Decreased magnesium level Rationale The use of a proton pump inhibitor for longer than a year can result in hypomagnesemia, which is indicated by the presence of a prolonged Q-T wave. Decreased calcium levels, thyroxin levels, and red blood cell count are not indicated by a prolonged Q-T wave.

A patient suffering from severe viral hepatitis is advised a liver function test by the health care provider. Which finding would the nurse expect in the patient's diagnostic report? Decreased direct bilirubin levels Decreased serum albumin levels Decreased alkaline phosphatase Decreased aspartate aminotransferase

Decreased serum albumin levels Rationale Hepatitis is characterized by inflammation of the liver, resulting in impairment of liver function. The liver is associated with the production of albumin, but because of impairment of its function, albumin levels are decreased. Decreased albumin levels are observed in the liver diagnostic reports of a hepatitis patient. Impaired liver function is also associated with increased bilirubin levels, which may further lead to jaundice. The alkaline phosphatase levels are increased due to blockage of their flow from the biliary tract and do not indicate hepatitis. Levels of aspartate aminotransferase are elevated if any organ has disease or injury.

Which predisposing conditions are related to xerostomia? Select all that apply. Rhinitis Depression Tuberculosis Bronchiectasis Diabetes mellitus

Depression Diabetes mellitus Rationale Xerostomia is a condition in which the flow of saliva is either partially or completely stopped. It is associated with loss of taste and difficulty in chewing and swallowing food. Diseases related to xerostomia include depression and diabetes mellitus. Rhinitis, tuberculosis, and bronchiectasis are associated with halitosis.

Which premedication assessments should be done on a female patient taking a gastrointestinal prostaglandin medication? Select all that apply. Determine whether the patient is pregnant. Check the bowel elimination pattern. Check renal function test results. Determine whether other drugs being taken may induce extrapyramidal symptoms. Check liver function test results.

Determine whether the patient is pregnant. Check the bowel elimination pattern. Check renal function test results. Rationale Gastrointestinal prostaglandin medication includes misoprostol. The nurse should determine whether the patient is pregnant before administering this medication because of the risk of miscarriage. The pattern of bowel elimination should also be checked because misoprostol may induce diarrhea. The renal function test results should be checked to ensure that renal function is normal for patients taking an antacid because antacids inhibit magnesium and potassium ion excretion, which may lead to hypermagnesemia and hyperkalemia. Extrapyramidal symptoms are assessed before administering metoclopramide therapy because this may increase anxiety and irritability. Cimetidine in high doses can affect liver functioning.

The health care provider prescribes diphenoxylate hydrochloride with atropine (Lomotil) for a patient .Which condition is the patient most likely suffering from ? Pain Diarrhea Colon cancer Hypertension

Diarrhea Rationale Diphenoxylate hydrochloride with atropine sulfate Lomotil is a common medication used to treat diarrhea .It is an antidiarrheal .Analgesics are used in pain management .Chemotherapy is used to treat colon cancer .Calcium channel blockers are usually used to treat hypertension .

A nurse is caring for a patient who will undergo a tube gastric analysis in 2 0hours .Which medication ,if prescribed ,would prompt the nurse to hold the medication and speak to the provider ? Ketorolac (Toradol) Celecoxib (Celebrex) Dicyclomine (Bentyl) Montelukast (Singulair)

Dicyclomine (Bentyl)

A nurse is caring for patient with cancer of the small intestine that required the removal of the duodenum and the jejunum .The nurse knows the patient will have difficulties with which physiologic process? Digestion Excretion Metabolism Mastication

Digestion Rationale Approximately 9 0%of digestion occurs in the small intestine .Removal of the duodenum and jejunum would decrease nutrient absorption as well such as in dumping syndrome .Mastication ,metabolism ,and excretion do not occur in the small intestine and would not be affected by cancer in the small intestines .

Which drug does the nurse expect the health care provider to prescribe to reduce nausea in a patient with severe liver dysfunction? Dimenhydrinate (Dramamine) Hydroxyzine pamoate (Vistaril) Hydroxyzine hydrochloride (Atarax) Prochlorperazine maleate (Compazine)

Dimenhydrinate (Dramamine) Rationale The metabolism of oral drugs takes place in the liver. Patients with liver dysfunction cannot clear the drug from their systems, and this would result in toxicity. Dimenhydrinate (Dramamine) has an easy first-pass metabolism and can be cleared from the system more effectively when compared to other antiemetic drugs. Hydroxyzine pamoate (Vistaril) is an antiemetic but is contraindicated in patients with liver dysfunction. Hydroxyzine hydrochloride (Atarax) is also an antiemetic, contraindicated in patients with liver dysfunction. Prochlorperazine maleate (Compazine) is another drug that reduces nausea but is contraindicated in patients with liver dysfunction.

A patient with late-stage cirrhosis is experiencing nausea and vomiting. The nurse anticipates the provider to prescribe which medication to alleviate nausea and vomiting? Diphenhydramine (Benadryl) Hydroxyzine pamoate (Vistaril) Hydroxyzine hydrochloride (Atarax) Prochlorperazine maleate (Compazine)

Diphenhydramine (Benadryl) Rationale Diphenhydramine (Benadryl) or dimenhydrinate (Dramamine) may be prescribed for nausea and vomiting in the patient with cirrhosis. Hydroxyzine pamoate (Vistaril), hyd roxyzine hydrochloride (Atarax), and prochlorperazine maleate (Compazine) is contraindicated in patients with severe liver damage.

Which type of medicine may cause xerostomia? Diuretics Cytotoxics Corticosteroids Immunosuppressants

Diuretics Rationale Diuretics may cause xerostomia (dry mouth). Cytotoxics, corticosteroids, and immunosuppressants are not associated with xerostomia, but they may cause candidiasis.

Following a gastrectomy performed for peptic ulcer disease ,the patient has recovered and is ready for discharge .What instructions should the nurse include in discharge teaching to prevent dumping syndrome ? Divide meals into six small feedings . Take fluids along with meals . Use concentrated sweets ,such as honey ,jam ,and jelly . Reduce protein and fats in the diet .

Divide meals into six small feedings . Rationale To prevent dumping syndrome after gastrectomy ,the patient should avoid large meals and ,instead ,divide meals into six small meals to avoid overloading the intestines at mealtimes .Fluids should not be taken with meals .Fluids can be taken at least 3 0to 4 5minutes before of after meals .This helps prevent distention or a feeling of fullness .Concentrated sweets should be avoided because they sometimes cause dizziness ,diarrhea ,and a sense a sense of fullness .Protein and fats should be increased in the diet to help rebuild body tissue and to meet energy needs .

A nurse is caring for a patient scheduled for laparoscopic cholecystectomy. In the patient's chart, the nurse finds signed consent forms for laparoscopic cholecystectomy and open cholecystectomy. Which action should the nurse take? Cancel the surgery until the medical team is clear on the plan. Discard the open cholecystectomy consent form to prevent confusion. Call the health care provider immediately to rectify the situation. Do nothing. Both consent forms are necessary in case the surgical plan changes.

Do nothing. Both consent forms are necessary in case the surgical plan changes. Rationale A consent form for both the laparoscopic and open cholecystectomies should be signed and placed in the patient's chart in case the surgical plan must be changed during the operation. The nurse does not need to call the health care provider, cancel the surgery, or discard the open cholecystectomy consent form.

Which condition indicates a need for esophageal manometry ? Pyrosis Dysphagia Leukoplakia Hematemesis

Dysphagia Rationale Esophageal manometry is used when the patient shows symptoms of achalasia ,such as dysphagia .The test shows the absence of primary peristalsis .Pyrosis refers to heartburn that is seen in patients with gastroesophageal reflux disease (GERD). GERD is detected with an esophageal pH test .Leukoplakia is a white firmly attached patch on the mouth or tongue mucosa and is a manifestation of oropharyngeal cancer .Hematemesis ,or vomiting blood ,occurs as a result of gastric bleeding .The symptom can be diagnosed by testing the stools for occult blood .

A patient is undergoing diagnostic tests to rule out carcinoma of the oral cavity .Which symptoms have been associated with the disease ? Select all that apply . Dysphagia Toothache Regurgitation Mouth edema Chronic cough Constant earache Difficulty in chewing ,swallowing ,or speaking Numbness or loss of sensation in part of the mouth

Dysphagia Toothache Mouth edema Constant earache Difficulty in chewing ,swallowing ,or speaking Numbness or loss of sensation in part of the mouth

A nurse is providing education to a patient taking tetracycline for chlamydia .Which instruction would be best for promoting the growth of healthy bacteria ? Increase fluid intake . Use a firm toothbrush . Eat plain yogurt for breakfast . Use mouthwash after brushing teeth .

Eat plain yogurt for breakfast . Rationale Eating plain yogurt for breakfast encourages the growth of normal bacteria to prevent super infections and candidiasis .The patient should use a soft -bristled tooth brush to prevent trauma to the tissues .Although use of mouthwash and increasing fluid intake are good practices ,they are not applicable to promoting the growth of healthy bacteria .

Which interventions does the nurse include in a discussion about nonpharmacologic interventions to supplement drug therapy with a patient with peptic ulcer disease? Select all that apply. Eat smaller, more frequent meals. Sit upright at the table when eating. Limit fluid intake to mealtimes if possible. Do not lie down for at least 2 hours after meals. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain or fever.

Eat smaller, more frequent meals. Sit upright at the table when eating. Do not lie down for at least 2 hours after meals. Rationale Patients experiencing stomach issues should eat smaller, more frequent meals, sit upright at the table when eating, and not lie down until 2 hours after eating. Fluid intake should occur mostly between meals and be limited during meals. NSAIDs should be avoided because they aggravate gastric mucosa.

What complications are associated with cirrhosis of the liver? Select all that apply. Edema of feet Difficulty breathing Disorientation and lethargy Blood in the stools or black stools Severe pain in the chest and a cold sweat

Edema of feet Disorientation and lethargy Blood in the stools or black stools Rationale Complications of cirrhosis of the liver include peripheral edema, gastric varices, and hepatic encephalopathy. Peripheral edema presents itself as swelling/edema of feet. Hepatic encephalopathy presents as disorientation, altered mental status, sleep disturbances, and lethargy. Gastric varices bleed easily. This bleeding can be presented as blood in the vomitus or in the stool. Cirrhosis does not lead to pain in the chest, a cold sweat, or difficulty breathing.

Which interventions would the nurse include when teaching a patient about the methods of bowel training ?Select all that apply . Encourage exercise . Have the patient increase fluid intake . Ensure high fiber intake . Ensure a diet low in bulk . Provide privacy for toileting .

Encourage exercise . Have the patient increase fluid intake . Ensure high fiber intake . Provide privacy for toileting . Rationale The patient is encouraged to perform regular exercise as exercise strengthens the abdominal muscles .Increased fluid intake makes it easier for the patient to pass stool .The interventions for bowel training include ensuring higher fiber intake to aid defecation .A high -fiber diet increases roughage and aids in defecation .Privacy during toileting facilitates defecation because the patient is more comfortable .The nurse ensures a diet high in bulk to promote regular bowel movements .

Which nursing interventions are appropriate to prevent respiratory complications in a patient who has just undergone liver transplantation? Select all that apply. Encourage the patient to cough. Consider repositioning the patient. Encourage the patient to take deep breaths. Instruct the patient to walk around the bed. Administer cough suppressants to prevent coughing.

Encourage the patient to cough. Consider repositioning the patient. Encourage the patient to take deep breaths. Rationale The patient who has had a liver transplant requires highly skilled nursing care in the intensive care unit (ICU) or another specialized unit. To prevent respiratory complications, the patient should be encouraged to use such measures as coughing, repositioning, and deep breathing. The patient can be ambulated later, when the condition is stable. Administering cough suppressants would be counterproductive to recovery.

Which nursing intervention is important to prevent complications after an upper gastrointestinal study with barium ? Ensure increase in fluid intake . Encourage a diet high in protein . Encourage the patient to ambulate as little as possible . Assess gag reflex before allowing the patient to eat or drink .

Ensure increase in fluid intake . Rationale The patient should increase fluid intake to promote the expulsion of the barium and prevent a hardened barium impaction .It will also be important for the patient to ambulate frequently to promote peristalsis .high -protein diet and assessment of the gag reflex are not necessary .

A patient with which condition should not receive metoclopramide? Epilepsy Diabetes Hypertension Coronary artery disease

Epilepsy Rationale Metoclopramide will increase the frequency and severity of seizures; a patient with epilepsy should not receive this medication. Metoclopramide does not affect diabetes, coronary artery disease, or blood pressure.

Which medication could be beneficial for the treatment of intermittent heartburn? Misoprostol Esomeprazole Metoclopramide Sucralfate

Esomeprazole Rationale Esomeprazole is a proton pump inhibitor that is available over-the-counter; it is used to treat intermittent heartburn. Misoprostol is prescribed to treat gastric ulcers caused by prostaglandin inhibitors. Metoclopramide is used to relieve the symptoms of gastric reflux esophagitis and diabetic gastroparesis. Sucralfate is used to treat duodenal ulcers.

A patient arrives at the clinic complaining of severe heartburn that began month ago and has persisted despite diet change and over -the-counter(OTC)histamine-2receptor blockers .The nurse knows that medical management of severe gastroesophageal reflux disease (GERD) is vital to prevent which long -term complication ? Malnutrition Barrett stomach Esophageal cancer Intestinal perforation

Esophageal cancer Rationale Unmanaged GERD can lead to erosion of the esophagus and Barrett 's esophagus (not stomach ),which can become esophageal cancer .Malnutrition ant intestinal perforation are not long -term complications of severe GERD .

Which diagnostic test involves visualization of the esophagus ,stomach ,and duodenum via a flexible endoscope ? Colonoscopy Sigmoidoscopy Barium swallow Esophagogastroduodenoscopy

Esophagogastroduodenoscopy

nurse instruct a patient to use to prevent plaque formation? Saline rinses Magnesium hydroxide (Milk of Magnesia) Amlexanox (Aphthasol) Flossing between teeth

Flossing between teeth Rationale Flossing between teeth helps remove dental plaque. Saline rinses are indicated for treatment of canker sores. Magnesium hydroxide (Milk of Magnesia) is indicated for treatment of mucositis. Amlexanox is indicated for the treatment of canker sores.

Which instruction is beneficial to a patient on long-term omeprazole (Prilosec) therapy for gastric and duodenal ulcers? Discontinue the medication if you have a headache. Frequently undergo tests to determine bone mass. Eat foods that are low in calcium. Avoid foods rich in vitamin D.

Frequently undergo tests to determine bone mass. Rationale Long-term use of proton pump inhibitors such as omeprazole (Prilosec) can make the patient more prone to hip, wrist, and spine fractures. Therefore the patient should undergo frequent bone mass monitoring. Omeprazole (Prilosec) may cause headaches; the patient should consult the healthcare provider but should not discontinue the medication on his or her own. Long-term use of omeprazole (Prilosec) can lead to a risk of osteoporosis; therefore the patient should ingest foods rich in calcium and vitamin D.

Which diagnostic test is preferred for visualizing the biliary tree in a patient with jaundice? Cholecystography Gallbladder ultrasonography Oral cholecystography (OCG) Intravenous cholangiography (IVC)

Gallbladder ultrasonography Rationale The preferred diagnostic test for visualizing the biliary tree in a patient with jaundice is a gallbladder ultrasound. OCG is : method of visualizing the biliary tree, but it is ineffective in the patient with jaundice. IVC is a method of visualizing the biliary tree, but it is ineffective in the patient with jaundice. Cholecystography is another term for OCG.

A nurse who is preparing to care for a patient diagnosed with cholecystitis knows the patient most likely also has which condition? Cirrhosis Gallstones Alcoholism Hypercholesterolemia

Gallstones Rationale Gallstones are the cause of cholecystitis in 90% of cases. Hypercholesterolemia may contribute to the formation of gallstones, but this is not always the case. Cirrhosis and alcoholism are not the primary cause of cholecystitis.

Which statement best describes the action of antacids? Gastric acid in the stomach is neutralized. Gastric acid secretion is inhibited. Antacids cause the thickness of the gastric mucus to be increased. Gastric mucosa is desensitized to the effects of acid.

Gastric acid in the stomach is neutralized. Rationale Antacids lower the acidity of gastric secretions by buffering the hydrochloric acid to a lower hydrogen ion concentration. Antacids do not inhibit gastric acid secretion; histamine-receptor antagonists and gastric acid pump inhibitors do this. Antacids do not increase the thickness of the gastric mucus and do not desensitize the mucosa.

Which assessment finding in a patient with gastritis indicates a need for fluid and blood replacement and nasogastric (NG) lavage? Dysphagia Gastric ulcer Excess gastric motility Gastrointestinal bleeding

Gastrointestinal bleeding Rationale A patient with gastrointestinal bleeding caused by hemorrhagic gastritis requires fluid and blood replacement along with NG lavage .Dysphagia refers to difficulty swallowing ,which is relieved by surgery or dilation .Misoprostol ( Cytotec) therapy is used to treat gastric ulcers .Gastric motility is decreased by vagotomy ,Billroth I or ll procedure that involves the removal of the vagal innervation to the fundus .

The nurse is caring for a patient with metastatic adenocarcinoma of the pancreas. Which drug does the nurse expect to find in the patient's prescription? Vasopressin (Pitressin) Cholestyramine (Questran) Spironolactone (Aldactone) Gemcitabine hydrochloride (Gemzar)

Gemcitabine hydrochloride (Gemzar) Rationale Gemcitabine hydrochloride (Gemzar) is used to treat patients with metastatic adenocarcinoma of the pancreas. Vasopressin (Pitressin) is an antidiuretic drug, used to treat bleeding esophageal varices in patients. Cholestyramine (Questran) is used to relieve pruritus associated with elevated levels of bile acids. Spironolactone (Aldactone) is used to treat cirrhosis of the liver with ascites.

Which food would be most appropriate for a patient who recently had a bout of acute pancreatitis? Select all that apply. Chips and salsa Eggs and bacon Coffee and Danish pastry Grilled chicken and a baked potato Reduced-fat cheese and whole-wheat crackers

Grilled chicken and a baked potato Reduced-fat cheese and whole-wheat crackers Rationale The optimal diet for a patient who has recently had pancreatitis is a bland, low-fat, high-protein, high-carbohydrate diet. The reduced-fat cheese and whole-wheat crackers and chicken and baked potato best meet these recommendations. Chips and salsa would not be the best choice because salsa is not considered a bland food. Eggs and bacon would not be a good choice; this is neither a bland nor a low-fat meal. Coffee and Danish pastry would not be the best choice because coffee is a gastric stimulant and the pastry is likely to be high in fat.

Which antiulcer medication when combined with warfarin therapy increases a patient's risk for gastrointestinal bleeding? Select all that apply. Prokinetic agents H 2-receptor antagonist Gastrointestinal prostaglandin Proton pump inhibitors Coating agents

H 2-receptor antagonist Proton pump inhibitors Rationale A histamine-receptor antagonist and omeprazole, a proton pump inhibitor, may increase the risk of gastrointestinal bleeding when coadministered with warfarin. The therapeutic effect of prokinetic agents is reduced by coadministering anticholinergic agents with narcotic analgesics. There is no significant drug interactions associated with gastrointestinal prostaglandins. Coating agents may interfere with the absorption of tetracycline.

A nurse is assisting with a paracentesis for a patient with ascites caused by cirrhosis. Which action should the nurse take first? Monitor for signs of syncope. Have the patient empty the bladder. Position patient in high-Fowler's position. Observe the site for bleeding or drainage.

Have the patient empty the bladder. Rationale The patient should empty the bladder before the paracentesis to prevent puncture of the bladder. Then, the patient should be positioned sitting on the side of the bed or in high-Fowler's position. While the fluid is being removed, the nurse should monitor the patient for signs of syncope. After the procedure, the nurse should observe the dressing site for bleeding and drainage.

During an assessment of a patient, the nurse finds asterixis, twitching of the extremities, and notices that the patient is displaying inappropriate behavior and disorientation. Which condition does the nurse suspect in this patient? Ascites Liver cirrhosis Esophageal varices Hepatic encephalopathy

Hepatic encephalopathy Rationale Hepatic encephalopathy is a type of brain damage caused by liver disease. The patient's signs and symptoms progress from inappropriate behavior, disorientation, asterixis, and twitching of the extremities. Symptoms of ascites include loss of appetite, nausea and vomiting, general weakness, and fatigue. Liver cirrhosis is characterized by dyspepsia, changes in bowel habits, gradual weight loss, ascites, enlarged spleen, malaise, nausea, jaundice, and ecchymoses. Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension. It may lead to bleeding in the esophagus if not treated, but it is not accompanied by such symptoms as asterixis, twitching of the extremities, inappropriate behavior, and disorientation.

Which form of hepatitis, with an incubation period of 10 to 40 days, is most common today? Hepatitis A Hepatitis B Hepatitis C Hepatitis D

Hepatitis A Rationale Hepatitis A is the most common form of hepatitis today. Formerly termed infectious hepatitis, it is a short-incubation virus (10-40 days). Hepatitis B is a long-incubation virus (28-160 days). Persons at risk for hepatitis B include health care workers, persons with high-risk lifestyles (drug users, tattoo recipients, homosexual men, and sex workers), infants born to mothers who are hepatitis B surface antigen (HBsAg) positive, hemodialysis patients, and persons sharing a household with a person infected with hepatitis B. Hepatitis C has an incubation period of 2 weeks to 6 months, commonly 6 to 9 weeks. Hepatitis D, also known as the delta virus, has an incubation period of 2 to 10 weeks. It causes hepatitis as coinfection with hepatitis B and may progress to cirrhosis and chronic hepatitis.

Which condition might be present in a patient who is taking a peptic a ulcer medication and has elevated alkaline phosphatase level and prothrombin time? Hepatotoxicity Gynecomastia Hypomagnesemia Dizziness

Hepatotoxicity Rationale Simultaneous use of misoprostol (Cytotec) with magnesium-containing antacids can increase the patient's risk of diarrhea. Therefore the patient should avoid taking these medications together. Taking the medication at bedtime reduces the risk of diarrhea. Taking misoprostol (Cytotec) on an empty stomach increases the risk of diarrhea. Including sufficient roughage such as fresh fruits and whole-grain products in the diet reduces the risk of diarrhea.

The nurse would assess for which increased risk factor during a follow-up for a patient taking a high dose of omeprazole (Prilosec) for more than a year? Constipation Hepatotoxicity Hypomagnesemia Hip, wrist, or spine fractures

Hip, wrist, or spine fractures Rationale Long-term use and high doses of omeprazole (Prilosec) place the patient at greater risk of fractures of the hip, wrist, and spine. Diarrhea, not constipation, is an adverse effect of omeprazole (Prilosec) use. Hepatotoxicity is a risk related to use of histamine-2 receptor antagonists, not omeprazole. Hypermagnesemia is a more common risk after one year of omeprazole (Prilosec) use.

Which factors may lead to the development of ascites? Select all that apply. Diabetes mellitus Hyperaldosteronism Portal hypertension Decreased flow of hepatic lymph Decreased serum colloidal oncotic pressure

Hyperaldosteronism Portal hypertension Decreased serum colloidal oncotic pressure Rationale Hyperaldosteronism or increased secretion of aldosterone causes ascites. Portal hypertension causes an increase in resistance to blood flow in the liver leading to ascites. When there is decreased serum colloidal oncotic pressure, there is impairment of synthesis of albumin and loss of albumin in the peritoneal cavity. It leads to ascites. Diabetes is a metabolic syndrome and does not cause ascites. Increased flow of hepatic lymph, not decreased flow, leads to ascites.

A patient with asthma is using royal jelly for pancreatitis. Which parameter would the nurse monitor to ensure the patient's safety? Hypotension Hypokalemia Hypoglycemia Hypersensitivity

Hypersensitivity Rationale Royal jelly (bee pollen complex) is used in treating pancreatitis. Hypersensitive reactions should be monitored in patients with asthma using royal jelly for pancreatitis. If the patient is allergic to royal jelly, it may lead to asthma attacks, anaphylaxis, and even death. Patients with pancreatitis are not at risk of hypotension, and royal jelly does not alter blood pressure. Hypoglycemia is not related to pancreatitis. Royal jelly has good glucose supplements and does not diminish glucose content. Neither pancreatitis nor royal jelly is associated with hypokalemia.

Which statement made by a patient indicates a need for further education of the use of metoclopramide? "I should avoid driving after taking metoclopramide tablets." I should avoid taking metoclopramide tablets if have nausea. "I should avoid working around machinery while taking metoclopramide tablets." "I should avoid taking metoclopramide tablets just before meals."

I should avoid taking metoclopramide tablets if have nausea. Rationale Metoclopramide (Reglan) may cause nausea; if this condition occurs, the patient should consult the healthcare provider immediately but should not stop taking the medication on his or her own. Metoclopramide (Reglan) may cause dizziness and weakness; therefore the patient should avoid driving and working around machinery while taking this medication. Patients should take metoclopramide at least 30 minutes before meals to ensure effective absorption.

Which products are effective at reducing mouth dryness? Select all that apply. Water-based lubricant (K-Y Jelly) Ice chips Cocoa butter Chewing gum Petroleum jelly

Ice chips Chewing gum

Which advice would the nurse give to a patient experiencing heartburn after meals ? Sleep flat ,with no pillows . Take histamine -2(H2 )blockers. Lie flat after meals for 3 0minutes . Identify and avoid causative foods .

Identify and avoid causative foods .

What are the therapeutic outcomes of mouthwashes? Select all that apply. Improvement in halitosis Reduction in plaque formation Reduction in cavities Temporary reduction in bleeding Temporary reduction in irritation

Improvement in halitosis Temporary reduction in bleeding Temporary reduction in irritation Rationale Therapeutic outcomes of mouthwashes include improvement in halitosis and a temporary reduction in bleeding and irritation. Reduction in plaque formation and cavities can be observed with the use of dentifrices.

Which advice would the nurse give to a patient reporting constipation ? Halt physical activity . Increase your intake of fluids . Consume a low -fiber diet . Take medicine for constipation daily .

Increase your intake of fluids .

Which laboratory findings indicate a patient taking ranitidine is experiencing hepatotoxicity? Select all that apply. Increased bilirubin level Increased alkaline phosphatase level Increased alanine aminotransferase level Decreased aspartate aminotransferase level Decreased gamma-glutamyl transferase level

Increased bilirubin level Increased alkaline phosphatase level Increased alanine aminotransferase level Rationale H2-receptor antagonists such as ranitidine (Zantac) may rarely induce hepatotoxicity. This condition is indicated by increased levels of bilirubin, alkaline phosphatase, and alanine aminotransferase. Increased, not decreased, levels of aspartate aminotransferase and gamma-glutamyl transferase indicate hepatotoxicity.

Which basic principle does the nurse consider when scheduling the administration of drugs used to treat patients with GERD or peptic ulcer disease (PUD)? These drugs must be given with meals or snacks. Individualized scheduling is required to avoid drug interactions. These drugs are taken only in the presence of active symptomatology. Significant fluid and electrolyte imbalances are associated with these drugs.

Individualized scheduling is required to avoid drug interactions. Rationale Each type of drug used to treat GERD or PUD may require somewhat different scheduling to avoid drug interactions. Many of these drugs are given routinely, not just when symptoms are present. The absence of symptoms indicates that they are working. With prescribed use, these drugs do not have significant effects on fluid and electrolyte balance. These drugs do not need to be given with meals; other prescribed drugs should be scheduled 1 hour before or 2 hours after antacids.

A patient is admitted to the hospital because of vomiting that has lasted 3 days despite minimal intake and severe abdominal distention and pain .Which intervention should the nurse perform first ? Administer a laxative to promote bowel evacuation . Insert a nasojejunal tube ,and connect it to wall suction . Provide preoperative education about colostomy formation . Prepare the patient for surgery to repair the intestinal obstruction .

Insert a nasojejunal tube ,and connect it to wall suction .

A nurse is caring for a patient with vitamin B 1 2deficiency and knows the patient likely has a deficiency of which substance ? Mucin Chyme Intrinsic factor Immunoglobulin

Intrinsic factor Rationale Intrinsic factor promotes the absorption of vitamin 1 2.Mucin ,chyme ,and immunoglobulin are not involved in the absorption of vitamin B 1 2.

Which action by a patient is most beneficial for a patient who has mucositis and now has a fungal infection? Irrigating the mouth every hour Irrigating the mouth every 2 hours Irrigating the mouth immediately before and after meals and at bedtime Irrigating the mouth immediately before administering topical agents

Irrigating the mouth immediately before administering topical agents Rationale If a patient with mucositis is diagnosed with fungal infection, the patient should irrigate his or her mouth immediately before the administration of topical agents such as nystatin liquids. This action will improve the contact of the medicine with the denuded surface of the oral mucosa. If the symptoms are mild and a fungal infection is not present, then the patient should irrigate his or her mouth immediately before and after meals and at bedtime. If the symptoms are moderate and a fungal infection is not present, then the patient should irrigate his or her mouth every 2 hours. If severe symptoms are present without any fungal infection, then the patient should irrigate his or her mouth every hour.

A patient who underwent a cholecystectomy is now complaining of pain radiating to his right shoulder. Which causes may be responsible for this pain? Select all that apply. Myocardial infarction Pericarditis after surgery Gallstone left accidentally Irritation of the phrenic nerve Carbon dioxide used in surgery

Irritation of the phrenic nerve Carbon dioxide used in surgery Rationale The carbon dioxide that is used to inflate the abdomen during surgery may not be released or absorbed by the body and can irritate the phrenic nerve and the diaphragm. This is the reason for breathing difficulty and the most common cause of shoulder pain after cholecystectomy. Other conditions, such as myocardial infarction, pericarditis after surgery, and a gallstone left in the gall bladder, may also cause shoulder pain but are less relevant in this situation.

A patient with cancer of the head of the pancreas is admitted to the hospital. Which manifestations would the nurse expect to find in this patient? Select all that apply. Jaundice Itching and irritation of the skin Ulcers on the back and abdomen Swelling of the face and extremities Extreme pain in the upper abdomen that may radiate to the back

Jaundice Itching and irritation of the skin Extreme pain in the upper abdomen that may radiate to the back Rationale Most often the head of the pancreas is involved and causes jaundice by compressing and obstructing the common bile duct. Pruritus is also a common symptom in cancer of the pancreas; hence, the patient may complain of itching and irritation of the skin. Abdominal pain in the midepigastric region or back occurs in many of the patients. Edema and ulcers are not common manifestations of pancreatic cancer.

Which mechanism causes itching for a patient with intense pruritus? Ascites, which causes dry skin Poor diet, which causes pH imbalances of the skin Poor hygiene, which causes dead skin cells to build-up Jaundice, which causes the accumulation of bile salts under the skin

Jaundice, which causes the accumulation of bile salts under the skin Rationale The accumulation of bile salts causes jaundice and pruritus in the patient with liver cirrhosis. The patient's pruritus is not caused by ascites, poor diet, or poor hygiene.

A nurse is administering lactulose to a patient with hepatic encephalopathy caused by liver cirrhosis. The patient's wife requests to know why her husband is being given this medication because he is not constipated. The nurse replies that lactulose decreases ammonia levels through which mechanism? Lactulose increases the bacterial metabolism of ammonia. Lactulose decreases bacterial production of ammonia. Lactulose reduces the number of ammonia-producing bacteria in the colon. Lactulose increases the number of ammonia-metabolizing bacteria in the colon.

Lactulose increases bacterial metabolism of ammonia. Rationale Lactulose acidifies the bowel, which decreases the production of ammonia by bacteria in the bowel. Bacteria in the bowel do not metabolize ammonia. Neomycin, not lactulose, reduces the number of ammonia-producing bacteria in the colon.

Which tests does the nurse expect the health care provider to prescribe for a patient suspected of having oropharyngeal cancer ? Select all that apply . Manometry Laryngoscopy Excisional biopsy Oral exfoliative cytology Radiographic evaluation

Laryngoscopy Excisional biopsy Oral exfoliative cytology Radiographic evaluation

Which mouthwash might a patient be used to prevent aspiration while having a painful Candida infection and sore throat? Antiseptic mouthwash (Listerine) Lidocaine viscous 2% Chlorhexidine (Peridex) A 0.9% solution of sodium chloride

Lidocaine viscous 2% Rationale Lidocaine viscous 2% is used to treat painful candidal infections. A patient should not eat or drink anything for 30 minutes after administering this mouthwash because of the absence of the gag reflex and potential risk for aspiration. Listerine is effective at reducing plaque. Chlorhexidine (Peridex) is used to treat mucositis. A 0.9% solution of sodium chloride temporarily relieves pharyngeal irritation from nasogastric tubes, endotracheal tubes, sore throat, or oral surgery.

A patient comes to the clinic complaining of heartburn after meals and is diagnosed with gastroesophageal reflux disease .Which dietary instructions should the nurse include in teaching ? Increase fat intake . Limit caffeinated foods and drinks . Eat three balanced meals every day . Remain upright for 4 hours after eating .

Limit caffeinated foods and drinks .

A nurse is caring for a patient with moderate symptoms caused by three gallstones. Which procedure would the nurse prepare the patient for? Lithotripsy Open cholecystectomy Endoscopic sphincterotomy Laparoscopic cholecystectomy

Lithotripsy Rationale Mild to moderate symptoms caused by just a few gallstones are treated by lithotripsy to break up the stones. Open cholecystectomy, endoscopic sphincterotomy, and laparoscopic cholecystectomy are reserved for the treatment of multiple gallstones and more serious diseases.

A patient arrives at the clinic with a yellow discoloration of the skin and the sclera. The nurse anticipates the health care provider will prescribe tests to determine the function of which organ? Liver Spleen Kidneys Small intestine

Liver Rationale Bilirubin, which is normally broken down in the liver, causes jaundice, a yellow discoloration of the skin when the liver is not functioning properly. Jaundice is not caused by spleen, kidney, or small intestine dysfunction.

Which body part is the largest glandular organ in the body that functions as an accessory organ of digestion ? Liver Stomach Pancreas Small intestine

Liver Rationale The largest glandular organ in the body ,which functions as an accessory organ of digestion ,is the liver .It is also one of the most complex .In the adult it weighs 3 pounds .The pancreas is an accessory organ digestion ;however ,it is not the largest .The small intestine is not an accessory organ of digestion ,but rather a digestive organ .It is 2 0feet in length inch in diameter .The stomach is not an accessory organ of digestion ,but rather a digestive organ .The stomach churns and contracts to mix and compress its contents with gastric juices and water .

Which accessory organs aid in the digestive process ?Select all that apply . Liver Pancreas Gallbladder Large intestine Salivary glands

Liver Pancreas Gallbladder Salivary glands Rationale Accessory organs aid in digestion but are not a part of the digestive tract .For instance ,the liver produces bile that is necessary for the emulsification of fats .In addition ,the liver has many other functions ,such as management of blood coagulation ;metabolization of proteins ,fats ,and carbohydrates ;and storage of glycogen for later use .The pancreas aids in the digestion of proteins ,fats ,and carbohydrates .The pancreas contains sodium bicarbonate ,which neutralizes hydrochloric acid in the gastric juices that enter the small intestine from the stomach .The gallbladder stores and ejects bile into the duodenum for the digestion of fats .The salivary glands produce saliva ,which helps dissolve food and begins the chemical process of digestion .The large intestine is an important organ of the digestive system that completes the absorption of water ,manufactures vitamins ,forms feces ,and expels feces .

Which condition does the nurse suspect in a patient with dull abdominal pain, clay-colored stools, dark urine, fever, hepatomegaly, jaundice, and anemia? Cholecystitis Liver abscess Liver cirrhosis Hepatic encephalopathy

Liver abscess Rationale Liver abscess is the collection of pus in the liver caused by bacterial infections. These infections retard the liver's function, and the patient experiences dull abdominal pain. Abnormal functioning of the liver results in increased bilirubin content, indicated by clay-colored stools and dark urine. Hepatomegaly, jaundice, and anemia in the patient confirm the presence of liver abscess. Cholecystitis is characterized by such symptoms as pain in the right upper quadrant epigastric region, anorexia, nausea, vomiting, and flatulency. Liver cirrhosis is characterized by dyspepsia, changes in bowel habits, gradual weight loss, ascites, enlarged spleen, malaise, nausea, jaundice, and ecchymoses. Hepatic encephalopathy is characterized by symptoms that progress from inappropriate behavior, disorientation, asterixis, and twitching of the extremities.

A patient who has been diagnosed with gastroesophageal reflux disease (GERD) asks the nurse why symptoms are persisting even after diet modifications and medications .The nurse bases the reply on which pathophysiologic change ? Slow gastric emptying Poor treatment compliance Increased intestinal motility Lower esophageal sphincter relaxation

Lower esophageal sphincter relaxation Rationale Lower esophageal sphincter relaxation leads to stomach contents moving through the sphincter up into the esophagus .Slow gastric emptying may contribute to GERD ,but this is not the best answer .Increased intestinal motility would cause diarrhea .The patient is clearly compliant with treatment .

A patient with cholecystostomy has an accidental obstruction of bile drainage. Which nursing intervention may reduce the risk for impaired skin integrity? Maintaining patency of the T-tube Applying enough tension on the T-tube Emptying the bile bag after it is completely filled Changing and applying moist dressing, as ordered

Maintaining patency of the T-tube Rationale Maintaining the patency of the T-tube is a primary nursing intervention. This promotes the draining of the obstructed bile through the opening of the T-tube. Drainage of the obstructed bile retards if pressure is applied on the T-tube. If the bag is changed after it is fully filled, it may soil the linen, causing discomfort to the patient. The bile bag should be emptied after it is half-filled. Moist dressing may cause infections; the dressing applied should be dry.

Which nursing action is important after a patient has a partial gastrectomy to prevent further complications ? Prohibit foods containing wheat in the patient 's diet . Measure the patient 's blood serum vitamin B12 level . Apply an ice bag to relieve abdominal pain . Provide a list of foods that cause constipation .

Measure the patient 's blood serum vitamin B 1 2 level . Rationale After a partial gastrectomy ,there is a deficiency of intrinsic factor ,which aids intestinal absorption of vitamin B 2.This can result in pernicious anemia .Therefore ,the nurse needs to make sure the patient 's serum vitamin B 1 2level is measured .Wheat is prohibited in patients who are allergic to gluten or have celiac disease .Abdominal pain in the patient may indicate postoperative bleeding ,which may need surgical intervention .The patient will most need a pain medication to assist with the pain .Constipation is not a severe complication of partial gastrectomy .

Which medication could be beneficial for a patient with barium remaining in the intestine after and upper gastrointestinal series with barium? Sucralfate Nizatidine Metoclopramide Rabeprazole

Metoclopramide Rationale Metoclopramide (Reglan) is used to stimulate gastric emptying and to promote the intestinal transit of barium. Sucralfate is used to treat duodenal ulcers. Nizatidine is used to treat gastroesophageal reflux disease (GERD), duodenal ulcers, and pathologic hypersecretory conditions. Rabeprazole is used to treat severe esophagitis, GERD, gastric and duodenal ulcers, and hypersecretory disorders.

A patient is diagnosed with diabetic gastroparesis. Which medication does the nurse recognize as appropriate in treating a patient with diabetic gastroparesis? Omeprazole Dexlansoprazole Metoclopramide Famotidine

Metoclopramide Rationale Metoclopramide treats diabetic gastroparesis by increasing peristalsis in the gastrointestinal tract, which results in an increased rate of gastric emptying and intestinal transit time. Omeprazole and dexlansoprazole are prescribed to treat severe esophagitis, hyperacidity, and gastric and duodenal ulcers. Famotidine is used to treat gastroesophageal reflux disease, duodenal ulcers, and pathologic hypersecretory conditions.

Which medication is used to treat gastric reflux esophagitis? Sucralfate (Carafate) Lansoprazole (Prevacid) Metoclopramide (Reglan) Dexlansoprazole (Dexilant)

Metoclopramide (Reglan) Rationale Metoclopramide (Reglan) is prokinetic agent used to treat gastric reflux esophagitis. Sucralfate (Carafate) is used to treat duodenal ulcers. Lansoprazole (Prevacid) and dexlansoprazole (Dexilant) are proton pump inhibitors that reduce the risk of gastric and duodenal ulcers.

Which medication is most beneficial to treat a patient with a nonsteroidal anti-inflammatory drug (NSAID)-related gastric ulcer? Ranitidine Misoprostol Rabeprazole Pantoprazole

Misoprostol Rationale Prostaglandins, which are normally present in the gastrointestinal tract, inhibit the section of gastric acid and pepsin and therefore protect the stomach and duodenal lining against ulceration. NSAIDs reduce pain and inflammation by inhibiting prostaglandins and make the patient more prone to gastric ulcers. Misoprostol can effectively treat ulcers caused by prostaglandin inhibitors and reduce pain. Ranitidine, rabeprazole, and pantoprazole do not reduce gastric ulcers by antagonizing prostaglandin inhibitors.

A patient asks the nurse if there is a medication to help decrease the risk of a peptic ulcer due to long-term nonsteroidal antiinflammatory drug (NSAID) use. Which drug does the nurse identify as a possibility? Cimetidine (Tagamet HB) Misoprostol (Cytotec) Pantoprazole (Protonix) Metoclopramide (Reglan)

Misoprostol (Cytotec) Rationale Misoprostol (Cytotec) is used to prevent and treat gastric ulcers caused by prostaglandin inhibitors such as NSAIDs. Cimetidine (Tagamet HB), pantoprazole (Protonix), and metoclopramide (Reglan) are not used for this purpose.

Which medication is contraindicated in pregnancy? Cimetidine (Tagamet) Misoprostol (Cytotec) Esomeprazole (Nexium) Metoclopramide (Reglan)

Misoprostol (Cytotec) Rationale Misoprostol (Cytotec) is a gastrointestinal prostaglandin inhibitor prescribed to treat gastric ulcers. However, this medication is contraindicated in pregnant women because it may cause a miscarriage as a result of its uterine stimulant activity. Cimetidine may cause gynecomastia. Esomeprazole may cause hypomagnesemia. Metoclopramide may cause drowsiness, fatigue, lethargy, and dizziness.

A patient with cholelithiasis is complaining of severe abdominal pain. Which pain medication ordered by the provider would the nurse question? Morphine Ketorolac (Toradol) Dicyclomine (Bentyl) Meperidine (Demerol)

Morphine Rationale Morphine can cause an increased tone in the sphincter of Oddi and slow the flow of bile into the duodenum, which can lead to an increase in symptoms. Ketorolac and meperidine are good options for pain control. Dicyclomine decreases spasms of the sphincter of Oddi and pain.

Which medication does the nurse anticipate will be ordered for a patient with xerostomia? MouthKote Silver nitrate Nystatin (Mycostatin) Palifermin (Kepivance)

MouthKote Rationale MouthKote is artificial saliva used to treat xerostomia. Nystatin is an antifungal agent used to treat Candida albicans infections. Palifermin is a human keratinocyte growth factor, and it has been approved specifically for use in preventing and treating mucositis that develops in leukemia or lymphoma patients undergoing chemotherapy before bone marrow transplantation. Silver nitrate is an antiseptic and astringent and is not indicated for treatment of xerostomia.

Chemotherapy makes patients more susceptible to which oral condition? Plaque Mucositis Cold sores Canker sores

Mucositis Rationale After chemotherapy, the patient is at increased risk for developing mucositis. Mucositis develops 5 to 7 days after chemotherapy. Plaque develops as a result of bad oral hygiene. Cold sores arevcaused by the herpes simplex type 1 virus (herpes simplex labialis). The cause of canker sores is unknown, but they are unrelated to chemotherapy.

Which condition does the healthcare provider want to prevent in a patient who undergoes radiation therapy? Mucositis Cold sores Xerostomia Canker sores

Mucositis Rationale After radiation therapy, the patient becomes more susceptible to mucositis. Therefore the healthcare provider would advise the patient to start performing better oral hygiene just after radiation therapy. Radiation therapy is not associated with the development of cold sores, xerostomia, and canker sores.

Which intervention would be the most effective for the treatment of secondary infections in a patient with cold sores? Aspirin Naproxen Neosporin Zilactin B

Neosporin Rationale a Neosporin is effective in treating secondary infections that develop in patient with cold sores. Aspirin and naproxen (Aleve) are oral analgesics that provide relief from the pain caused by cold sores; they are not effective for the treatment of secondary infections. Zilactin B temporarily relieves pain and itching and prevents drying of the lesion. However, it is ineffective in treating secondary infections.

Which drug does the nurse anticipate the healthcare provider will prescribe for a patient who has small, red papules at the junction of the mucous membrane and the skin of the lips and a secondary bacterial infection? Naproxen (Naprosyn) Neosporin (Medi-Quik) Benzocaine (Zilactin B) Hydrogen peroxide (Colgate Peroxyl)

Neosporin (Medi-Quik) Rationale Cold sores are lesions that are visible as small, red papules and develop into fluid-filled vesicles. The drying and cracking of cold sores may increase the patient's susceptibility to secondary bacterial infections. They can be treated with a topical antibiotic ointment such as Neosporin (Medi-Quik). Naproxen (Naprosyn) is an oral analgesic that significantly relieves pain. Local anesthetics such as benzocaine may temporarily relieve the pain and itching and prevent the lesion from drying. Hydrogen peroxide (Colgate Peroxyl) can be used as a debriding and cleansing agent for canker sores.

A patient taking cimetidine presents with bradycardia, hypotension, and fatigue. Which additional patient medications may be responsible for these effects? Select all that apply. Warfarin Nifedipine Misoprostol Imipramine Diltiazem

Nifedipine Diltiazem Rationale Cimetidine inhibits the metabolism of nifedipine and diltiazem. This drug-drug interaction may lead to symptoms of bradycardia, hypotension, and fatigue in patients taking these medications concurrently. Cimetidine may enhance the anticoagulant effects of warfarin, which can cause bleeding symptoms, but not bradycardia, hypotension, or fatigue. Cimetidine taken concurrently with misoprostol is not known to cause symptoms of bradycardia, hypotension, or fatigue. Cimetidine taken concurrently with imipramine may cause increased anticholinergics effects such as dry mouth, constipation, urinary retention, and dilated pupils.

Which antiulcer medications act by antagonizing histamine-2 (H 2) receptors? Select all that apply. Nizatidine (Axid) Famotidine (Pepcid) Misoprostol (Cytotec) Cimetidine (Tagamet) Esomeprazole (Nexium)

Nizatidine (Axid) Famotidine (Pepcid) Cimetidine (Tagamet) Rationale Antiulcer medications such as nizatidine (Axid), famotidine (Pepcid), and cimetidine (Tagamet) antagonize H 2 receptors and therefore decrease the volume of acid a secretion. Misoprostol (Cytotec) is synthetic prostaglandin that acts by inhibiting gastric acid and pepsin secretion. Esomeprazole (Nexium) acts by inhibiting proton pumps.

A patient with late-stage liver cirrhosis arrives in the clinic with several complaints. Which symptom concerns the nurse the most because it puts the patient at risk for a potentially life-threatening complication? Pruritus Diarrhea Nonproductive cough Increased abdominal girth

Nonproductive cough Rationale The patient with cirrhosis is at risk for esophageal varices, which can rupture when the patient coughs and cause hemorrhage. Diarrhea, pruritus, and increased abdominal girth are all symptoms expected to be present in a patient with cirrhosis.

A patient arrives at the clinic complaining of white patches on the tongue and inner cheeks .The patient has a history of diabetes mellitus and current diagnosis of chlamydia infection ,for which the patient is taking tetracycline .The nurse anticipates the provider will prescribe which medication ? Nystatin (Nystop) Penicillin (Permapen) Griseofulvin (Gris-PEG) Azithromycin (Zithromax)

Nystatin (Nystop) Rationale risk factors for candidiasis .Assessment finding of candiasis are sores and white patches .Nystatin swish and swallow is used to treat candiasis .Penicillin and azithromycin are antibiotics and ,therefore ,inappropriate for treatment .Griseofulvin is an antifungal medication but is not used for oral candidiasis .

The nurse is called to the room of a patient who is vomiting and notes the vomitus has an appearance like coffee grounds .Which action should the nurse take first ? Call the provider . Document the findings . Obtain patient 's vital signs . Check patient 'sblood glucose level .

Obtain patient 's vital signs . Rationale Coffee grounds -like vomitus is indicative of blood in the stomach .The nurse should determine the patient 's vital signs to determine the extent of the bleeding .Then ,the nurse should call the provider .It may be necessary to check the patient 's glucose level ,but this is not the first action .The nurse should document the findings after the vital signs are obtained and the provider is notified .

A patient undergoing a paracentesis to remove ascitic fluid complains of dizziness and lightheadedness. Which action should the nurse take first? Increase the flow of fluid. Decrease the flow of fluid. Obtain the patient's vital signs. Remove the catheter immediately.

Obtain the patient's vital signs. Rationale The patient is likely experiencing syncope because the fluid was removed too quickly. The nurse should first determine the patient's blood pressure and pulse. It may be necessary to decrease the flow of fluid, but the nurse should first determine the cause of the patient's symptoms. It would not be appropriate to increase the flow of fluid or remove the catheter immediately.

Which action by the unlicensed assistive personnel (UAP) in the postprocedure care of a patient who is returning from an upper gastrointestinal ( GI)endoscopy would prompt the nurse to intervene immediately ? Taking vital signs Offering the bedpan Turning the patient in bed Offering ice chips and water

Offering ice chips and water Rationale During an upper endoscopy ,the patient 's pharynx is sprayed with a local anesthetic medication .The nurse must first determine that the patient 's gag reflex has returned before the patient is allowed anything by mouth .It is appropriate for the UAP to take vital signs ,offer the bedpan ,and turn the patient .

Which medication might cause increased bruising and increased prothrombin time when taken with warfarin? Diazepam Sucralfate Omeprazole Metoclopramide

Omeprazole Rationale Omeprazole inhibits the metabolism of warfarin; therefore the tendency to bleed increases and may result in an increased prothrombin time. The metabolism and excretion of diazepam is increased coadministration with omeprazole, but this will not increase the incidence of bruising. Sucralfate inhibits the absorption of omeprazole. Metoclopramide decreases the effects of levodopa.

Which medication when given with phenytoin can cause rapid involuntary eye movements, reduced irritability, and lack of energy? Clopidogrel Sucralfate Warfarin Omeprazole

Omeprazole Rationale Rapid involuntary movement of the eyes, reduced irritability, and a lack of energy may occur when omeprazole slows the metabolism of phenytoin, which may cause nystagmus, sedation, and lethargy. A combination of clopidogrel and omeprazole may increase the risk of gastrointestinal bleeding. Sucralfate inhibits the metabolism of omeprazole. The metabolism of warfarin is reduced when coadministered with omeprazole and may increase the risk of bleeding tendencies.

The nurse discovers a patient is sitting up in bed reading the newspaper after having had a fine-needle aspiration biopsy (FNAB) of the liver 15 minutes before. Which position would the nurse place the patient in? On the patient's left side On the patient's right side Semi-Fowler's position Trendelenburg's position

On the patient's right side Rationale After FNAB of the liver, it is important for the patient to lie on the right side for a minimum of 2 hours to splint the puncture site. In this position, the liver capsule is compressed against the chest wall, thereby decreasing the risk of hemorrhage or bile leak. Trendelenburg's position is not the recommended position after FNAB of the liver. Placement on the patient's left side is also not the recommended position because the liver is located on the patient's right. Semi-Fowler's position is not the recommended position after FNAB of the liver.

On the patient's right side Rationale After FNAB of the liver, it is important for the patient to lie on the right side for a minimum of 2 hours to splint the puncture site. In this position, the liver capsule is compressed against the chest wall, thereby decreasing the risk of hemorrhage or bile leak. Trendelenburg's position is not the recommended position after the FNAB of the liver. Placement on the patient's left side is also not the recommended position because the liver is located on the patient's right. Semi-Fowler's position is not the recommended position after the FNAB of the liver.

Which devices would be effective in reducing a patient's pain and discomfort from advanced lesions with mucositis? Select all that apply. Oral syringe Soft-bristled brush Water flosser (Waterpik) on low setting Sponge-tipped applicator Gravity flow irrigating system

Oral syringe Gravity flow irrigating system Rationale An oral syringe and a gravity flow irrigating system can reduce pain and discomfort in a patient with mucositis who has advanced lesions. A soft-bristled brush, a water flosser (Waterpik) on low setting and a sponge-tipped applicator are used for oral hygiene maintenance.

What does grade M on the World Health Organization Oral Mucositis Scale indicate? Oral feeding not possible Oral soreness with erythema Oral ulcers, liquid diet tolerated Oral erythema and ulcers, solid diet tolerated

Oral ulcers, liquid diet tolerated Rationale Grade 3 on the World Health Organization Oral Mucositis Scale indicates that the patient has oral ulcers and can tolerate a liquid diet. Grade 1 indicates oral soreness with the erythema. Grade 2 indicates that the patient has oral erythema and ulcers, and the patient can tolerate a solid diet. Grade 4 indicates that oral feeding is not possible.

The nurse instructs a patient diagnosed with canker sores to avoid drinking which beverage? Apple juice Grape juice Mango juice Orange juice

Orange juice Rationale Citrus juices such as grapefruit and orange juice should be avoided because they can cause irritation to canker sores. Apple juice, grape juice, and mango juice do not cause increased irritation to canker sores.

Which medication does the nurse anticipate the healthcare provider will order for a patient undergoing chemotherapy before a bone marrow transplant that has developed mucositis? Silver nitrate Palifermin Hydrogen peroxide Carbamide peroxide

Palifermin Rationale Palifermin is a human keratinocyte growth factor and has been approved specifically for use in preventing and treating mucositis that develops in leukemia or lymphoma patients who undergoing chemotherapy before bone marrow transplantation. Carbamide peroxide and hydrogen peroxide are oxygen-releasing agents and are indicated for treatment of canker sores. Silver nitrate is not indicated for the treatment of mucositis.

Which intervention prescribed by the healthcare provider would help prevent mucositis in a patient scheduled for bone marrow transplantation and undergoing chemotherapy? Naproxen (Aleve) Neomycin (Neosporin) Palifermin (Kepivance) Zilactin B (Benzocaine 10%)

Palifermin (Kepivance) Rationale Palifermin (Kepivance) is a recombinant human keratinocyte growth factor that can prevent mucositis in a client with hematologic malignancies who is undergoing chemotherapy before bone marrow transplantation. Naproxen (Aleve), neomycin (Neosporin), and Zilactin B (benzocaine 10%) are effective for the treatment of cold sores.

Which medications reduce gastric ulcers by inhibiting hydrogen ion pumps? Select all that apply. Amoxicillin (Amoxil) Cimetidine (Tagamet) Misoprostol (Cytotec) Pantoprazole (Protonix) Dexlansoprazole (Dexilant)

Pantoprazole (Protonix) Dexlansoprazole (Dexilant) Rationale Proton pump inhibitors such as pantoprazole (Protonix) and dexlansoprazole (Dexilant) reduce the risk of gastric ulcers by inhibiting hydrogen ion pumps. Amoxicillin (Amoxil) treats Helicobacter pylori infections by inhibiting the bacterial growth. Cimetidine (Tagamet) treats gastric ulcers by antagonizing H 2 receptors. a Misoprostol (Cytotec) is gastrointestinal prostaglandin that inhibits gastric acid and pepsin secretion and therefore protects the stomach and duodenal lining against ulceration.

A patient with cirrhosis of the liver is admitted to the hospital for moderate respiratory distress as a result of ascites. The nurse knows to prepare the patient for which procedure? Paracentesis Thoracentesis Esophagoscopy Barium esophagography

Paracentesis Rationale Paracentesis is a procedure in which fluid is withdrawn from the abdominal cavity. This buildup of fluid is likely the cause of the patient's respiratory distress. A thoracentesis drains fluid from the chest cavity and is not applicable to this patient. Although the patient may need an esophagoscopy with barium esophagography to determine if the patient has esophageal varices, these are not the best options at this time.

Which medicinal agents are excreted through the lungs and leave a characteristic foul mouth odor? Select all that apply. Menthol Allantoin Camphor Paraldehyde Dimethyl sulfoxide (DMSO)

Paraldehyde Dimethyl sulfoxide (DMSO) Rationale Paraldehyde and DMSO are medicinal agents that are excreted primarily through the lungs. These agents leave a characteristic foul odor in the mouth. Topical analgesics such as allantoin, menthol, camphor, and phenol are safe and effective for temporarily reducing pain in cold sores.

Which medicinal agents are excreted through the lungs and leave a characteristic foul mouth odor? Select all that apply. Menthol Allantoin Camphor Paraldehyde Dimethyl sulfoxide (DMSO)

The nurse is a caring for a patient with a chronic hepatitis B infection. Which drug does the nurse expect the health care provider to prescribe to treat the infection and decrease the viral load? Ribavirin (Rebetol) Pegylated interferon alfa (Pegasys) Interferon alfa-2b (Intron A) Azathioprine (Imuran)

Pegylated interferon alfa (Pegasys) Rationale Drugs that are considered first-line treatment for chronic hepatitis B virus infection include pegylated interferon alfa (Pegasys), entecavir (ETV), and tenofovir disoproxil fumarate (TDF). Ribavirin (Rebetol) also decreases the viral load but treats hepatitis C infections. Interferon alfa-2b (Intron A) acts as a static drug and decreases the disease progression in hepatitis C infections. Azathioprine (Imuran) is an immunosuppressant used in liver transplant recipients.

Which complication of a peptic ulcer is the most lethal ? Bleeding Dyspepsia Perforation Gastric outlet obstruction

Perforation Rationale Perforation is considered the most lethal complication of a peptic ulcer ;therefore ,it should be the nurse 'stop concern .This occurs when the ulcer crater penetrates the entire thickness of the wall of the stomach or the duodenum .Bleeding ,which can be serious and difficult to control ( requiring the administration of blood products ) is not the most lethal complication of a peptic ulcer ,although surgery may be required to resolve the problem .Dyspepsia ,or the sensation of nausea ,eructation ,and distention ,is a symptom of a peptic ulcer ,not a complication .Gastric outlet obstruction may occur in the patient whose peptic ulcer lies close to the pylorus .It is a complication of peptic ulcer that can occur at any time ,but it is not considered to be the most lethal complication .

Which complications does the nurse monitor for while assessing a patient with peptic ulcer disease (PUD)? Select all that apply . Dysphagia Perforation Hemorrhage Gastric outlet obstruction Hematemesis and melena

Perforation Hemorrhage Gastric outlet obstruction Hematemesis and melena

Which chemicals are effective for tooth whitening? Select all that apply. Zinc citrate Zinc chloride Perhydrol urea Potassium nitrate Carbamide peroxide

Perhydrol urea Carbamide peroxide Rationale Perhydrol urea and carbamide peroxide are oxidizing ingredients that are effective tooth whiteners. Zinc citrate and zinc chloride prevent or retard the formation of new calculi from plaque. Potassium nitrate is effective at reducing oral sensitivity.

Which medication when given to a patient taking a proton pump inhibitor may cause nystagmus? Clopidogrel (Plavix) Phenytoin (Dilantin) Sucralfate (Carafate) Warfarin (Coumadin)

Phenytoin (Dilantin) Rationale Simultaneous use of proton pump inhibitors and phenytoin (Dilantin) can cause nystagmus (involuntary eye movements). Simultaneous use of clopidogrel (Plavix) and proton pump inhibitors will not result In nystagmus. Sucralfate (Carafate) inhibits the absorption of proton pump inhibitors but will not cause nystagmus. Warfarin (Coumadin) use along with a proton pump inhibitor can increase the risk of bleeding, but this combination will not cause nystagmus.

A patient with cirrhosis and esophageal varices is vomiting, and the nurse notes hematemesis. Which action should the nurse take first? Call the health care provider. Place the patient in the side-lying position. Stay with the patient until the vomiting subsides. Encourage the patient to continue vomiting to clear the stomach of blood.

Place the patient in the side-lying position. Rationale A bleeding varix is a medical emergency. An airway must be maintained, so the patient should first be placed in the side-lying position to prevent aspiration. The health care provider should then be notified. The nurse should stay with the patient until the vomiting subsides and ensure that the patient's airway is maintained. The patient should not be encouraged to continue vomiting.

Which type of liver cirrhosis is caused by viral hepatitis, exposure to hepatotoxins (e.g., Industrial chemicals), or infection? Laennec's cirrhosis Alcoholic cirrhosis Postnecrotic cirrhosis Primary biliary cirrhosis

Postnecrotic cirrhosis

Which ingredient(s) in toothpaste can help relieve oral sensitivity to hot and cold liquids? Potassium nitrate Zinc chloride, zinc citrate, and soluble pyrophosphate Sanguinarine, zinc citrate, triclosan, thymol, and eucalyptol Hydrogen peroxide, carbamide peroxide, and perhidrol urea.

Potassium nitrate Rationale Potassium nitrate is effective for reducing oral sensitivity. Chemicals such as sanguinarine, zinc citrate, triclosan, thymol, and eucalyptol have antibacterial properties that may reduce plaque. Zinc chloride, zinc citrate, and soluble pyrophosphates prevent or retard the formation of new calculus from plaque but will not remove calculus already formed. Oxidizing ingredients such as hydrogen peroxide, carbamide peroxide, and perhidrol urea are used for tooth whitening.

Which condition is a contraindication for prescribing a patient misoprostol? Glaucoma Pregnancy Hypothyroidism Diabetes mellitus

Pregnancy Rationale Misoprostol is a uterine stimulant and is contraindicated during pregnancy. Misoprostol is not contraindicated for patients with diabetes mellitus, glaucoma, or hypothyroidism.

Which educational topic should the licensed practical nurse (LPN) have addressed with the patient who has cold sores to prevent infection? Prevent the sore from drying out. Use silver nitrate excessively. Apply amlexanox paste 5% (Aphthasol) on the sores. Use phenol for a sustained period of time.

Prevent the sore from drying out. Rationale The drying and cracking of cold sores may cause secondary bacterial infections. Silver nitrate should not be used to cauterize canker sores because it may damage healthy tissue surrounding the lesion and predispose the area to later infection. Topical amlexanox paste 5% is an agent that hastens healing. Phenol is a local anesthetic, antiseptic, and antibacterial agent that penetrates and reduces plaque formation.

What is the specific purpose of fluoride-containing mouthwashes? Reducing gingivitis Treating oral mucositis Preventing dental caries Reducing plaque accumulation

Preventing dental caries Rationale Fluoride-containing mouthwashes prevent dental caries. The use of antiseptic mouthwash (Listerine) would reduce gingivitis. Chlorhexidine (Peridex) is an antibacterial agent that may treat oral mucositis. Medicinal mouthwashes such as Listerine help prevent plaque accumulation.

Which drug class hastens emptying of the stomach when administered to a patient for treatment of a stomach disorder? Antacids Prokinetic agents Proton pump inhibitors Histamine-2 antagonists

Prokinetic agents Rationale Prokinetic agents hasten stomach emptying by lowering esophageal sphincter muscle pressure and peristalsis. Antacids neutralize acid, thus leading to less acidity. Proton pump inhibitors block the formation of hydrochloric acid leading to less irritation. Histamine-2 antagonists decrease the volume of hydrochloric acid, thus increasing pH.

The nurse is caring for a patient with nonbleeding esophageal varices. Which drug does the nurse expect the health care provider to prescribe to ensure safety of the patient? Propranolol (Inderal) Cimetidine (Tagamet) Vasopressin (Pitressin) Nitroglycerin (Nitro-Bid)

Propranolol (Inderal) Rationale Esophageal varices are characterized by enlarged and edematous veins at the lower end of the esophagus. The patient is susceptible to hemorrhage; however, a few patients may not have bleeding. As this patient has no bleeding, prophylactic treatment with nonselective beta-blockers, such as propranolol (Inderal), reduces the risk of bleeding and bleeding-related deaths. Cimetidine (Tagamet) is an antacid and is used to prevent gastric stress ulcers. Vasopressin (Pitressin) is administered intravenously to stop hemorrhage and is not administered in the patient who does not have bleeding. Nitroglycerin (Nitro-Bid) is used for therapeutic management of ruptured esophageal varices.

Which nursing intervention would be the highest priority in managing a patient with a ruptured esophageal varix? Controlling bleeding Protecting the airway Performing a portacaval shunt Administering fresh frozen plasma (FFP)

Protecting the airway Rationale Although all answers may be important, the highest priority is airway protection. This may be accomplished via endotracheal intubation, if necessary. Control of bleeding is essential in managing the patient with a ruptured esophageal varix because death from hemorrhage may happen as a result of the high pressure and high vascularity of the area. Vasopressin may be administered for this purpose, and a Sengstaken-Blakemore tube may be inserted (balloon inflation helps achieve hemostasis). Performing a portacaval shunt diverts blood from the portal vein to the inferior vena cava. This may be used in an emergency situation to control acute bleeding or in a therapeutic situation when a patient has already bled. Administration of FFP as well as packed red blood cells (RBCs) is important in replacing the blood volume the patient has

The nurse would instruct a patient who is recovering from an acute episode of hepatic encephalopathy to avoid a diet rich in which component? Minerals Vitamins Proteins Carbohydrates

Proteins Rationale Ammonia is produced after the digestion of proteins. In patients with hepatic encephalopathy, ammonia cannot be eliminated from the body; protein intake is restricted in these patients. A protein-rich diet causes an excessive accumulation of ammonia in the body and is contraindicated in patients with hepatic encephalopathy. A diet rich in minerals is not contraindicated, and minerals are essential for the metabolic activities of the body. Vitamins are also required in moderate levels and are not contraindicated in patients with hepatic encephalopathy. Carbohydrates are not contraindicated in patients with hepatic encephalopathy. They are an essential source of glucose and can be taken in moderate amounts.

Which category of gastroesophageal medications could have placed the patient at a higher risk for fractures? Antacids Histamine-2 (H 2)-receptor antagonists Synthetic prostaglandin Proton pump inhibitor

Proton pump inhibitor Rationale Patients over the age of 50 who take proton pump inhibitors for more than a year may have an increased risk for hip and spinal fractures. Antacids and H 2-receptor antagonists may cause diarrhea or constipation. Synthetic prostaglandin E drugs can cause diarrhea.

Which medication class can be used in combination with antimicrobial agents to eradicate a Helicobacter pylori infection? Antacids Prokinetic agents Proton pump inhibitors Gastrointestinal prostaglandins

Proton pump inhibitors Rationale Proton pump inhibitors inhibit the gastric secretion of hydrochloric acid, reducing irritation caused by an infection. These medications are used in combination with antimicrobial agents such as amoxicillin, tetracycline, metronidazole, clarithromycin to eradicate this infection. Antacids are used to treat heartburn and neutralize acidic conditions. Prokinetic agents are used to treat GERD. Gastrointestinal prostaglandins are used to prevent and treat gastric ulcers caused by prostaglandin inhibitors.

Which class of medication is beneficial for the treatment of Zollinger- Ellison syndrome? Antacids Coating agents Gastrointestinal prostaglandin Proton pump inhibitors

Proton pump inhibitors Rationale Zollinger-Ellison syndrome occurs because of an overproduction of gastric acid. Proton pump inhibitors are used to treat Zollinger-Ellison syndrome by reducing the hyperacidity. Antacids neutralize gastric acid, which causes the gastric contents to be less acidic. Coating agents are used to treat existing ulcer craters on the gastric mucosa. Gastrointestinal prostaglandins are used to prevent and treat gastric ulcers caused by prostaglandin inhibitors (e.g., NSAIDs, including aspirin).

The nurse is caring for patient with severe liver cirrhosis and imbalanced nutrition. Which nursing intervention would prevent malnutrition in this patient? Encourage high protein intake. Provide oral care before meals. Provide large meals to the patient. Avoid administering antiemetic drugs to the patient.

Provide oral care before meals. Rationale The patient with liver cirrhosis shows less interest in food intake, which may lead to malnutrition. It is required to provide oral care to patients with liver cirrhosis before meals to remove the foul taste in their mouths and improve the taste of food. When digested, proteins produce ammonia, which is not eliminated in patients with severe liver cirrhosis. It is, therefore, not advised to provide protein-rich food. It is advised to provide small, frequent meals at times the patient can best tolerate them to prevent a feeling of fullness and maintain nutritional status. Antiemetics are to be administered, per the prescription, to relieve nausea and vomiting while eating.

Which medication should be prescribed with caution for a patient taking tetracycline? Sucralfate Warfarin Imipramine Cimetidine

Sucralfate Rationale Sucralfate may interfere with the metabolism of tetracycline. Tetracyclines should be administered 1 hour before or 2 hours after sucralfate. The metabolism of warfarin is reduced when coadministered with omeprazole. Cimetidine will inhibit the excretion of imipramine.

The nurhe nurse is beginning to teach a patient with gastroesophageal reflux disease (GERD)about lifestyle changes that can be implemented to minimize the symptoms of this disease .Which instruction will the nurse include ? A high -fat,low -protein diet will minimize the symptoms . Three meals per day ,spaced 6 hours apart ,is the optimal nutritional interval . A bedtime snack with a milk -based product will alleviate nighttime symptoms . Reducing caffeine and alcohol consumption may alleviate symptoms of the disease .

Reducing caffeine and alcohol consumption may alleviate symptoms of the disease . Rationale Reducing caffeine and alcohol consumption may alleviate symptoms of GERD .Caffeine can be found in chocolate ,coffee ,tea ,and even over -the-counter analgesics ,so checking labels is important .The meal recommendations for reducing the symptoms of GERD are for the patient to consume four to six small meals per day ( rather than three large meals ). A low -fat,adequate -protein diet may reduce symptoms for the patient with GERD .Evening snacks should be avoided for the patient with GERD ,and the patient should not eat for 2 to 3 hours before bedtime for the best chance of reducing symptoms of reflux .

mes are expected when a patient uses a dentifrice for an oral problem? Select all that apply. Refreshing taste Relief from irritation Reduction in cavities Reduction in plaque formation Temporary reduction in bleeding from the gums

Refreshing taste Reduction in cavities Reduction in plaque formation Rationale Dentifrices provide a refreshing taste. Dentifrices also help reduce cavities and plaque formation. Mouthwashes provide relief from oral irritation and temporary relief from bleeding gums.

with an unlicensed assistive personnel (UAP) to care for a patient with cirrhosis of the liver. The nurse overhears the UAP say, "This patient did this to himself by being an alcoholic. I don't understand why we're trying to save him." Which action should the nurse take? Report the UAP to the nurse manager. Say nothing. The UAP is entitled to an opinion. Remind the UAP that cirrhosis is also caused by factors other than alcohol. Tell the UAP, "You are right; we should not help him."

Remind the UAP that cirrhosis is also caused by factors other than alcohol. Rationale Cirrhosis of the liver can be caused by alcohol, hepatitis viruses, gallstones, and other causes. The nurse should first remind the UAP of these other causes. It is necessary to tell the UAP that each patient deserves the best care regardless of how the patient came to be in his or her condition. Should the UAP compromise the care of the patient, the nurse should report the UAP to the nurse manager. It is not appropriate to remain silent in this situation.

A patient with inflammatory bowel disease (IBD) arrives at the clinic for a yearly examination .The patient states ," I feel wonderful .I haven 't had any symptoms in 6 months ! "The nurse charts the patient 's disease as being at which stage ? Cured Remission Exacerbation Too early to document

Remission Rationale IBD occurs in a pattern of exacerbation and remission ;a patient in remission has few or no symptoms of the disease .An exacerbation is when the patient is experiencing symptoms of the disease .IBD cannot be cured ,and it would be inappropriate to chart nothing because the patient is exhibiting the normal disease pattern .

A patient with inflammatory bowel disease (IBD) arrives at the clinic for a yearly examination .The patient states ," I feel wonderful .I haven 't had any symptoms in 6 months !"The nurse charts the patient 's disease as being at which stage ? Cured Remission Exacerbation Too early to document

Which laboratory test does the nurse review before a patient takes a magnesium-based over-the-counter antacid for heartburn? Gastric pH Electrolytes Liver function Renal function

Renal function Rationale Renal function test results should be reviewed to ensure that renal function is normal. If renal failure is present, magnesium and potassium ions cannot be excreted, possibly leading to hypermagnesemia, hyperkalemia, and toxicity. Gastric pH, electrolytes, and liver function test results would not need to be reviewed before antacid use.

The nurse is caring for a patient with hepatic encephalopathy who is administered lactulose (Chronulac). Which biochemical level does the nurse monitor to ensure the patient's safety? Serum sodium Serum ammonia Serum creatinine Serum potassium

Serum ammonia Rationale The drug lactulose (Chronulac) retards ammonia absorption by acidifying the colonic contents. The nurse should, therefore, monitor serum ammonia levels after the administration of lactulose (Chronulac). The nurse should monitor serum sodium levels after administering vasopressin (Pitressin) because it is an antidiuretic. Serum creatinine levels should be monitored in the patient after the administration of spironolactone (Aldactone). Spironolactone (Aldactone) retains potassium in patients with liver cirrhosis; the nurse should, therefore, monitor serum potassium levels.

For which condition is esomeprazole (Nexium) typically prescribed? Select all that apply. Dysphagia Crohn's disease Severe esophagitis Zollinger-Ellison syndrome Gastroesophageal reflux disease (GERD)

Severe esophagitis Zollinger-Ellison syndrome Gastroesophageal reflux disease (GERD) Rationale Esomeprazole is a proton pump inhibitor often used to treat severe esophagitis, GERD, and Zollinger-Ellison syndrome. Esomeprazole is not indicated for the treatment of Crohn's disease or dysphagia.

Malabsorption can be a major problem in Crohn 'sdisease when which portion of the intestine is involved ? Stomach Esophagus Large intestine Small intestine

Small intestine Rationale Malabsorption can be a major problem with Crohn 's disease when the small intestine is involved .Megaloblastic anemia results from decreased absorption of vitamin B 1 in the small intestine .Fluid and electrolyte disturbances can occur ,particularly with depletion of sodium or potassium associated with diarrhea or excessive small intestine drainage through fistulas .Involvement of the esophagus or the stomach is rare in Crohn 's disease .In some patients ,the large intestine is involved ,and the patient is spared any changes in the small intestine ,thus minimizing malabsorption issues .These patients do not experience the problems with malabsorption ,which those with small intestine involvement experience .

Which dinner option would be best for a patient who was admitted with acute hepatic encephalopathy? Cheeseburger and French fries Grilled chicken with broccoli and cheese Spaghetti with marinara sauce and salad Ham and cheese sandwich with tomato soup

Spaghetti with marinara sauce and salad Rationale Patients recovering from acute hepatic encephalopathy may require a protein-restricted diet. Spaghetti with marinara sauce and salad is low in protein. Cheeseburgers, grilled chicken, and ham are all protein-rich foods.

Which meal ordered by a patient with a new diagnosis of celiac disease indicates a need for further dietary instructions ? Grilled shrimp with quinoa Chicken stir -fry with brown rice Spaghetti with meat sauce and whole -wheat noodles Sirloin steak fajitas with grilled peppers and onions in a corn tortilla

Spaghetti with meat sauce and whole -wheat noodles Rationale Whole -wheat noodles contain gluten and are prohibited for a patient with celiac disease .Grilled shrimp with quinoa ,chicken stir -fry with brown rice ,and fajitas in a corn tortilla are all good choices for a patient with celiac disease because they do not contain wheat ,rye ,or barley .

A 7 0-year-oldpatient experiences fecal incontinence .Which gastrointestinal structure involves fecal incontinence ? Mouth Rectum Stomach Sphincter

Sphincter Rationale In fecal incontinence ,the patient loses control of the sphincter muscles around the anus ,leading to involuntary excretion of bowel contents .The mouth is the first part of the digestive system ,which takes in food .The rectum is the distal part of the large intestine ,which holds feces .Stomach passes chyme to the large intestine and is not involved in excretion .

Which characteristic of pain is the nurse likely to find while interviewing a patient with a duodenal ulcer ? Stabbing and radiating up to shoulder Occurs 1 to 2 hours after a meal Located high up in the epigastrium Aggravated by food intake

Stabbing and radiating up to shoulder Rationale located lower in the abdominal region .The pain is not aggravated by food intake ;it takes a few hours before the pain begins in relation to food intake .

A patient admitted to the hospital with cirrhosis of the liver suddenly starts vomiting blood. Which nursing action is priority in this situation? Give propranolol orally. Check for signs of cirrhosis. Prepare the patient for endoscopic variceal ligation. Stabilize the patient, and manage the airway.

Stabilize the patient, and manage the airway. Rationale Individuals with cirrhosis of the liver are at risk of bleeding from esophageal and gastric varices. Hematemesis in the patient with cirrhosis of the liver is likely to be because of variceal bleeding. In this case, the nurse should first stabilize the patient and manage the airway. Once the patient is stable, other steps in treatment can be initiated, such as assessing further and administering medications, checking signs of cirrhosis, or preparing for further treatment.

Which diagnostic test does the nurse expect the health care provider to prescribe for a patient with diarrhea and an intestinal infection ? Manometry Esophagoscopy Stool culture test Barium enema (BE)study

Stool culture test Rationale The patient 's stool is examined for blood ,mucus ,and white blood cells ( WBCs) to detect intestinal infection .A culture is completed to evaluate if bacteria is growing in the stool ,which is the most common cause of diarrhea .Manometry and esophagoscopy are performed to diagnose achalasia .The BE study is used to detect the presence and location of abnormalities ,such as polyps ,tumors ,and diverticula .

Which precipitating factors are associated with canker sores? Select all that apply. Stress Malignancy Malnutrition Local trauma Diabetes mellitus

Stress Local trauma Rationale Canker sores may appear as ulcers on surfaces of the tongue, gums, and inner lining of the cheeks and lips. The precipitating factors of canker sores are stress and local trauma such as chemical irritation, toothbrush abrasion, and irritation from orthodontic braces. Predisposing factors for candidiasis include malignancies, malnutrition, and diabetes mellitus.

Which medications are included in the prescription of a patient who has severe episodes of gastroesophageal reflux disease (GERD)? Select all that apply . Paclitaxel (Taxol) Sucralfate (Carafate) Rabeprazole (Aciphex) Esomeprazole (Nexium) Metoclopramide (Reglan)

Sucralfate (Carafate) Rabeprazole (Aciphex) Esomeprazole (Nexium) Metoclopramide (Reglan)

Which statement is true regarding sucralfate (Carafate)? Sucralfate (Carafate) can induce diarrhea as an adverse effect. Sucralfate (Carafate) is a prokinetic agent that is used to treat duodenal ulcers. Sucralfate (Carafate) treats ulcers by inhibiting gastric secretions and altering gastric pH. Sucralfate (Carafate) is prescribed to patients who cannot tolerate other forms of antiulcer therapy.

Sucralfate (Carafate) is prescribed to patients who cannot tolerate other forms of antiulcer therapy. Rationale Sucralfate (Carafate) is used to treat duodenal ulcers, especially in patients who are unable to tolerate other forms of antiulcer therapy. Sucralfate (Carafate) may induce constipation, not diarrhea. Sucralfate (Carafate) is a coating agent that treats ulcers by forming a complex that adheres to the crater and protects it from acids, pepsins, and bile salts.

A nurse is preparing a patient for a fine-needle aspiration biopsy of the liver. The nurse correctly positions the patient in which manner? Prone Supine Lithotomy Trendelenburg's

Supine Rationale The patient should lie supine with the right arm elevated over the head. Prone, lithotomy, and Trendelenburg's positions would not be appropriate for this test.

What is the use of surfactants in mouthwashes? Surfactants kill bacteria. Surfactants remove debris. Surfactants neutralize sulfur-smelling compounds. Surfactants penetrate and reduce plaque formation.

Surfactants remove debris. Rationale Surfactants are foaming agents that help remove debris. Antimicrobial agents such as benzoic acid kill bacteria, which reduces plaque formation and decaying food odors. Zinc citrate and zinc chloride are astringents that neutralize sulfur-smelling compounds. Phenol is a local anesthetic, antiseptic, and antibacterial agent that reduces plaque formation.

a patient who underwent cholecystectomy. Which diagnostic test does the nurse expect the health care provider to prescribe to detect bile ductal stones? Urine amylase test Serum amylase test Oral cholecystography T-tube cholangiography

T-tube cholangiography Rationale T-tube cholangiography is performed to detect retained bile ductal stones postoperatively in the patient who had a cholecystectomy. The urine amylase test is particularly useful in detecting pancreatitis late in the course of the disease. The serum amylase test can aid in quickly diagnosing pancreatitis in its early stages. Oral cholecystography provides a radiographic visualization of the gallbladder.

Following a laparoscopic cholecystectomy, a patient without pre- or postoperative complications is being discharged from the hospital. Which instructions would the nurse include in the discharge teaching? Select all that apply. Take a shower. Increase fat in the diet during recovery. Wait 1 week after surgery to return to work. Take complete bed rest for at least 2 weeks. Notify the surgeon of any redness and swelling at the incision site.

Take a shower. Wait 1 week after surgery to return to work. Notify the surgeon of any redness and swelling at the incision site. Rationale The patient who undergoes a laparoscopic cholecystectomy without complications may be discharged shortly after surgery. Therefore, it iS important to teach the patient about care following discharge. The patient should be informed to take a shower. Normal activities can be resumed the next day, and the patient may return to work within 1 week of surgery. The patient should immediately notify the surgeon if there is redness, swelling, bile-colored drainage, or pus from any incision; severe abdominal pain; nausea; vomiting; and/or fever and chills. If the patient has no complications, the patient does not need to take bed rest for 2 weeks. A normal diet can also be resumed, but a low-fat diet is recommended for several weeks after surgery.

Which action by the patient can increase the risk of having diarrhea while taking misoprostol? Taking the medication at bedtime Not taking the medication on an empty stomach Taking the medication with magnesium-containing antacids Including fresh fruits and whole-grain products in the diet

Taking the medication with magnesium-containing antacids Rationale Simultaneous use of misoprostol (Cytotec) with magnesium-containing antacids can increase the patient's risk of diarrhea. Therefore the patient should avoid taking these medications together. Taking the medication at bedtime reduces the risk of diarrhea. Taking misoprostol (Cytotec) on an empty stomach increases the risk of diarrhea. Including sufficient roughage such as fresh fruits and whole-grain products in the diet reduces the risk of diarrhea.

Which event can alter a patient 's guaiac test results ? The stool specimen did not contain urine . The patient consumed fruit juice before the test . The patient consumed organ meat before the test . The nurse used tongue blades to transfer the stool .

The patient consumed organ meat before the test . Rationale If a patient consumes organ meat before the guaiac test ,the blood in the meat can turn the test result positive .Therefore ,the patient is instructed to avoid meat 2 4to 4 8hours before the test .If the stool specimen is contaminated with urine or toilet paper ,it may alter the test results .Fruit juice will not affect the guaiac results because it contains mostly water .Using tongue blades to transfer the specimen will prevent contamination .

The nurse is caring for several patients on a medical-surgical unit. Which patient is the nurse most concerned may develop a paralytic (adynamic) ileus? 1. The patient with impacted feces, tumor of the colon, or pancreatitis 2. The patient with an electrolyte imbalance, or acute inflammatory reactions 3. The patient with adhesions or a strangulated hernia 4. The patient with volvulus, intussusceptions, or electrolyte imbalances

The patient with volvulus, intussusceptions, or electrolyte imbalances Rationale: Paralytic ileus is the lack of peristalsis or bowel sounds, which is an ordinary form of nonmechanical obstruction, occurring following abdominal surgery. Causes include inflammatory responses such as pancreatitis and appendicitis, electrolyte imbalances (usually hypokalemia), and thoracic or lumbar spinal trauma. (p. 214)

A patient expresses concern about getting pregnant while the partner is on ribavirin (Rebetol) therapy for chronic hepatitis C. Which information would the nurse give to the patient? The person can plan pregnancy now. The person should avoid getting pregnant now. The person should not get pregnant with this partner. The person should avoid any sexual intercourse after conception.

The person should avoid getting pregnant now. Rationale Any woman who is on ribavirin (Rebetol) or whose male partner is on ribavirin should avoid pregnancy during treatment. Pregnancy can be planned after the treatment has been completed. The person can get pregnant with the current partner, but not while on treatment. Avoiding intercourse after conception is not necessary.

Which characteristic features are related to the lesions of canker sores? Select all that apply. They do not form blisters. They are usually gray or whitish-yellow. They coalesce into larger lesions. They first appear as small and red papules. They have an erythematous halo of inflamed tissue surrounding the ulcer crater.

They do not form blisters. They are usually gray or whitish-yellow. They have an erythematous halo of inflamed tissue surrounding the ulcer crater. Rationale Canker sores may appear as ulcers on the tongue, gums, or inner lining of the cheeks and lips. These lesions do not form blisters and usually appear to be gray or whitish yellow. These lesions do not grow together. They have an erythematous halo of inflamed tissue that surrounds the ulcer crater. Cold sores are caused by the herpes simplex type 1 virus. These lesions coalesce into larger lesions. They are visible as small, red papules that develop into fluid-filled vesicles.

Why would the health care provider prescribe cimetidine (Tagamet) to a patient with acute pancreatitis? To reduce stomach pH To prevent stress ulcers To treat secondary infections To increase pancreatic activity

To prevent stress ulcers Rationale Pancreatic juice is alkaline in nature, as it has more bicarbonate ions. It maintains the gastric pH; however, in patients with pancreatitis, pancreatic activity is reduced, which may result in stress ulcers. Therefore, antacids, such as cimetidine (Tagamet), should be prescribed to prevent stress ulcers. In pancreatitis, the pH of the stomach is reduced and cimetidine (Tagamet) is an antacid that elevates gastric pH. Secondary infections are not treated with cimetidine (Tagamet) because it is not an antibiotic. Cimetidine (Tagamet) is not associated with altering pancreatic activity.

A patient has persistent gastroesophageal reflux disease (GERD) despite diet change and proton pump inhibitors .Which test does the nurse anticipate being performed to determine lower esophageal sphincter (LES)competence? Exploratory laparotomy Upper gastrointestinal (Gl)endoscopy Chest radiography Magnetic resonance imaging (MRI)

Upper gastrointestinal (Gl)endoscopy Rationale en upper Gl endoscopy helps to determine LES competence .An exploratory laparotomy ,chest x -ray examination ,or MRI would not be helpful .

Which information does the nurse include when teaching a patient about oral care? Dentifrices are products designed to cleanse and whiten false teeth. Toothpastes vary in abrasiveness and should be selected accordingly. When choosing a mouthwash, use one with alcohol for the longest effect. Oral products are safe because they are topically applied and not absorbed systemically.

Toothpastes vary in abrasiveness and should be selected accordingly. Rationale Toothpaste does vary in abrasiveness, and patients should select one that best meets their needs. Dentifrices are tooth-cleaning substances. They contain one or more abrasive agents, a foaming agent, and flavoring materials. Some contain higher concentrations of abrasives than others and should be selected based on individual needs. They are used on natural and false teeth. Alcohol in mouthwash is drying to the mucous membranes. Oral products are applied topically, but depending on chemical composition and frequency of use, they may be absorbed and exert a systemic reaction.

A patient diagnosed with esophageal cancer has been undergoing radiation therapy .The patient 's white blood cell level is increased ,oxygen requirements have increased ,and lung sounds have decreased .A chest x -ray image shows aspiration pneumonia .The nurse concludes that this is a result of which problem associated with radiation treatment for esophageal cancer ? Goiter Gastroparesis Esophageal atresia Tracheoesophageal fistula

Tracheoesophageal fistula

Which imaging technique visualizes deep structures of the body by recording reflections or echoes of ultrasonic waves directed into the tissues? Angiography Hepatobiliary iminodiacetic acid (HIDA) scanning Ultrasonography Percutaneous biopsy

Ultrasonography

A patient has been prescribed misoprostol ( Cytotec) prevent nonsteroidal antiinflammatory drug (NSAID)-induced ulcer .Which instruction is the most important to give the patient ? Take the pill with milk . Use a reliable form of contraception . Take the pill 2 0minutes before a meal . Do not drink grapefruit juice while taking this pill .

Use a reliable form of contraception .

Which intervention recommended by a nursing student indicates a need for further education about mouthwashes that can relieve symptoms of mucositis? Use commercially prepared mouthwashes containing alcohol. Use 1.5% to 6% solutions of hydrogen peroxide as a mouthwash. Prepare mouthwash with 1 tbsp of salt in 8 oz of water. Prepare mouthwash with ½ tsp of baking soda in 8 oz of water

Use commercially prepared mouthwashes containing alcohol. Rationale Commercially prepared mouthwashes containing alcohol are usually not recommended because they may irritate the mouths of patients with mucositis. Using 1.5% to 6% solutions of hydrogen peroxide as mouthwash is also effective in reducing irritation. These patients can also prepare mouthwashes with l tbsp of salt or ½ tsp of baking soda in 8 oz of water. Using 1.5% to 6% solutions of hydrogen peroxide as mouthwash is also effective in reducing irritation.

Which nursing intervention may cause a patient harm who develops small, red lesions inside the mouth that become blisters and also reports burning, itching, and numbness in that area? Keep the area moist. Use highly astringent products. Gently wash the area using a mild soap solution. Encourage the patient to avoid contaminating other people.

Use highly astringent products. Rationale The patient should avoid using highly astringent product because these agents may cause cracking of the sores and increase the patient's susceptibility to secondary bacterial infections. The sores should be kept moist to prevent drying. The patient should use a mild soap solution to gently wash the area. When an active lesion is present, the sores are contagious. Therefore the patient should avoid contaminating others.

Which treatment regimens would be suitable for a patient who recently underwent chemotherapy and develops erythematous ulcerations intermixed with white, patchy mucous membranes in the mouth? Select all that apply. Use magnesium hydroxide (Milk of Magnesia). Use clotrimazole lozenges. Apply sucralfate suspensions topically. Use saline rinses in 4 to 8 ounces of warm tap water. Use ultraviolet blockers with a sun protection factor of at least 15.

Use magnesium hydroxide (Milk of Magnesia). Use clotrimazole lozenges. Apply sucralfate suspensions topically. Rationale Mucositis is a painful inflammation of the mucous membranes of the mouth that is commonly associated with chemotherapy and radiation therapy. The sores are erythematous ulcerations intermixed with white, patchy mucous membranes. Candidal infections are also detected in mucositis. The patient should use magnesium hydroxide (Milk of Magnesia) to rinse his or her mouth and coat the mucous membranes. Clotrimazole lozenges can reduce candidal oral infection. The topical application of sucralfate suspensions can relieve pain. Saline rinses are recommended for patients with canker sores. Ultraviolet blockers with a sun protection factor (SPF) of 15 are suitable for patients with cold sores caused by sun exposure.

Which signs and symptoms indicate carcinoma of the esophagus ? Select all that apply . Eructation Weight loss Hemorrhage Odynophagia Tracheoesophageal fistula

Weight loss Hemorrhage Odynophagia Tracheoesophageal fistula

Which action by a patient to treat painful, whitish yellow lesions on the tongue may cause severe chemical burns and necrosis on the same area? Use of artificial saliva products Use of aspirin on the lesions directly Use of viscous lidocaine before meals Use of oxygen-releasing agents for more than 3 days

Use of aspirin on the lesions directly Rationale Canker sores may appear as ulcers on the tongue. The lesions are usually gray to whitish yellow. Aspirin should not be placed on the lesions because it may cause severe chemical burns with necrosis. Xerostomia is treated by using artificial saliva products. However, the use of this medication is not related to burns and necrosis in canker sores. Viscous lidocaine 2% may cause a burn in the mouth if the patient consumes hot food after its use because the entire mouth and throat are anesthetized. Oxygen-releasing agents may cause tissue irritation and black hairy tongue with long-term use.

Which is the possible cause of a secondary infection in a patient with canker sores? Use of silver nitrate to cauterize lesions Sustained use of products containing eugenol Sustained use of products containing menthol Use of topical amlexanox paste 5% (Aphthasol)

Use of silver nitrate to cauterize lesions Rationale The use of silver nitrate to cauterize lesions should be discouraged because it may damage any healthy tissue surrounding the lesions and increase the risk of secondary infections in that area. Sustained use of products containing eugenol and menthol should be discouraged because their overuse may cause tissue irritation or systemic toxicity. The use of topical amlexanox paste 5% (Aphthasol) should be encouraged because it helps heal the canker sores.

The healthcare provider is treating a patient with mucositis and instructs the licensed practical nurse, "Be careful to avoid serving hot foods to the patient." Which treatment approach was most likely followed by the healthcare provider? Using silver nitrate Using magnesium hydroxide (Milk of Magnesia) Using 2% viscous lidocaine Using oxygen-releasing agents

Using 2% viscous lidocaine Rationale Lidocaine viscous 2% is a long-lasting local anesthetic that is used to treat sore throats or mouth ulcers. However, caution must be taken to ensure the patient is not burned by hot food because the entire mouth and throat are anesthetized. Silver nitrate should not be used to cauterize canker sores because it may damage healthy tissue surrounding the lesions and predispose the area to later infection. Magnesium hydroxide (Milk of Magnesia) is used to rinse the mouth and coat the mucous membranes. Oxygen-releasing agents can be used as debriding agents for canker sores up to four times a day for 7 days.

Which surgical procedures are used for the removal of stomach cancer ? Select all that apply . Vagotomy Antrectomy Gastrostomy Gastrojejunostomy Gastroduodenostomy

Vagotomy Antrectomy Gastrojejunostomy Gastroduodenostomy

Which action does the nurse anticipate to be beneficial for a pregnant patient in her first trimester who is prescribed misoprostol? Verify the order with the healthcare provider. Instruct her to take the medication at night. Give half of the dose of the medication immediately. Instruct her to take the medication with large amounts of water.

Verify the order with the healthcare provider. Rationale Prostaglandin E analogs such as misoprostol can be used to treat gastric ulcers, but they may also induce uterine contractions and result in a miscarriage. Therefore the prescription should be questioned and verified with the healthcare provider to ensure the patient's safety. Taking misoprostol at night would not prevent miscarriage. Halving the dose and taking the medication with large amounts of water will also not reduce the risk of a miscarriage.

Which condition is an adverse effect of omeprazole? Tachycardia Constipation Blurred vision Vesicular rash

Vesicular rash Rationale A persistent vesicular rash from omeprazole may be the cause for discontinuing therapy. Blurred vision and tachycardia are not adverse effects associated with omeprazole. Diarrhea, not constipation, is an adverse effect associated with omeprazole.

Which vitamin supplements does the health care provider prescribe for a patient with ascites? Select all that apply. Vitamin K Vitamin C Vitamin D Vitamin B 9 Vitamin B 12

Vitamin K Vitamin C Vitamin B 9 Rationale Patients with severe fluid retention are prescribed spironolactone (Aldactone) to promote dieresis. Vitamin supplements, such as vitamin K, vitamin C, and vitamin B (folic acid), also induce diuresis in the patient. These vitamin supplements synergize the actions of spironolactone (Aldactone) by promoting diuresis in severe conditions. Vitamin D is associated with the absorption of calcium in the intestines and is not associated with diuresis. Vitamin B 12 is associated with the formation of blood cells and does not produce any diuretic effect.

A nurse is contributing to the admission assessment of a patient in the early stages of cirrhosis of the liver. The nurse anticipates the patient to report which symptoms? Select all that apply. Pruritus Vomiting Diarrhea Flatulence Severe fatigue Loss of appetite

Vomiting Diarrhea Flatulence Loss of appetite Rationale In the early stages of cirrhosis of the liver, the patient experiences nausea and vomiting, abnormal bowel function, flatulence, weakness, and loss of appetite. Severe fatigue and pruritus are some of the symptoms experienced in the late stages.

At which time should a patient take misoprostol to minimize the incidence of diarrhea? With meals Between meals One hour before meals At bedtime with magnesium hydroxide (Milk of Magnesia)

With meals Rationale Taking misoprostol with meals and at bedtime and avoiding magnesium-containing antacids will help decrease diarrhea. The nurse should encourage the patient not to discontinue therapy without first contacting the healthcare provider. Taking misoprostol between meals or 1 hour before meals will not decrease the incidence of diarrhea. Taking misoprostol at bedtime will decrease the incidence of diarrhea, but it should not be taken with magnesium containing antacids such as magnesium hydroxide (Milk of Magnesia) because these antacids increase the incidence of diarrhea.

What is the oral cause of halitosis? Rhinitis Sinusitis Tonsillitis Xerostomia

Xerostomia Rationale Halitosis is a foul smell from the mouth. Xerostomia is an oral source responsible for halitosis. Rhinitis, sinusitis, and tonsillitis are nonoral sources that cause halitosis.

Which condition involves the partial or complete blockage of the flow of saliva? Plaque Halitosis Candidiasis Xerostomia

Xerostomia Rationale Xerostomia is a condition in which the flow of saliva is either partially or completely inhibited. It causes a loss of taste and difficulty in chewing and swallowing food. The plaque is a whitish-yellow substance that builds up on teeth and gum lines around the teeth. It is the primary cause of most teeth, gum (gingiva), and periodontal disease. Halitosis is a foul mouth odor. Candidiasis is a fungal infection caused by Candida albicans; this disease appears in debilitated patients taking a variety of medicines.

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