NUR 417 Exam 2 Part 2 | Complete Solutions (Answered)

NUR 417 Exam 2 Part 2 | Complete Solutions (Answered) A patient vomiting blood-streaked fluid is admitted to the hospital with acute gastritis. What would the nurse ask the patient about to determine possible risk factors for gastritis? 1. The amount of saturated fat in the diet 2. A family history of gastric or colon cancer 3. Use of nonsteroidal anti-inflammatory drugs 4. A history of a large recent weight gain or loss Use of an NSAID is associated with damage to the gastric mucosa, which can result in acute gastritis. Family history, recent weight gain or loss, and fatty foods are not risk factors for acute gastritis. A patient has peptic ulcer disease associated with Helicobacter pylori. Which medications will the nurse plan to teach the patient? 1. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol) 2. Metoclopramide (Reglan), bethanechol, and promethazine 3. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec) 4. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection. Which diagnostic test would the nurse anticipate for an older patient who is vomiting "coffee-ground" emesis? 1. Endoscopy 2. Angiography 3. Barium studies 4. Gastric analysis Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding. Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of famotidine (Pepcid)? 1. "Famotidine absorbs the excess gastric acid." 2. "Famotidine decreases gastric acid secretion." 3. "Famotidine constricts the blood vessels near the ulcer." 4. "Famotidine covers the ulcer with a protective material." Famotidine is a histamine-2 (H2) receptor blocker that decreases the secretion of gastric acid. Famotidine does not constrict the blood vessels, absorb the gastric acid, or cover the ulcer. A young adult patient is hospitalized with massive abdominal trauma from a motor vehicle crash. The patient asks about the purpose of receiving famotidine (Pepcid). Which information would the nurse explain about the action of the medication? 1. "It decreases nausea and vomiting." 2. "It inhibits development of stress ulcers." 3. "It lowers the risk for H. pylori infection." 4. "It prevents aspiration of gastric contents." Famotidine is administered to prevent the development of physiologic stress ulcers, which are associated with a major physiologic insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection. A patient admitted with a peptic ulcer has a nasogastric (NG) tube in place. When the patient develops sudden, severe upper abdominal pain, diaphoresis, and a firm abdomen, which action would the nurse take? 1. Irrigate the NG tube. 2. Check the vital signs. 3. Give the ordered antacid. 4. Elevate the foot of the bed. The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. Elevating the foot of the bed may increase abdominal pressure and discomfort, as well as making it more difficult for the patient to breathe. A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasing abdominal pain. The patient has no bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the past hour. Which nursing action is the highest priority? 1. Monitor drainage. 2. Contact the surgeon. 3. Irrigate the NG tube. 4. Give prescribed morphine. Increased pain and 200 mL of bright red NG drainage 12 hours after surgery indicate possible postoperative hemorrhage, and immediate actions such as blood transfusion or return to surgery are needed (or both). Because the NG is draining, there is no indication that irrigation is needed. Continuing to monitor the NG drainage is needed but not an adequate response to the findings. The patient may need morphine, but this is not the highest priority action. Which patient statement indicates that the nurse's postoperative teaching after a gastroduodenostomy has been effective? 1. "I will drink more liquids with my meals." 2. "I should choose high carbohydrate foods." 3. "Vitamin supplements may prevent anemia." 4. "Persistent heartburn is expected after surgery." Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery, and the patient should call the health care provider if this occurs. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome. At his first postoperative checkup appointment after a gastrojejunostomy (Billroth II), a patient reports that dizziness, weakness, and palpitations occur about 20 minutes after each meal. Which action would the nurse teach the patient to take? 1. Increase the amount of fluid with meals. 2. Eat foods that are higher in carbohydrates. 3. Lie down for about 30 minutes after eating. 4. Drink sugared fluids or eat candy after meals. The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down for a short rest after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome. A patient who takes a nonsteroidal anti-inflammatory drug (NSAID) daily for the management of severe rheumatoid arthritis has recently developed melena. What would the nurse anticipate teaching the patient? 1. Substitution of acetaminophen (Tylenol) for the NSAID 2. Use of enteric-coated NSAIDs to reduce gastric irritation 3. Reasons for using corticosteroids to treat the rheumatoid arthritis 4. Misoprostol (Cytotec) to protect the gastrointestinal (GI) mucosa Misoprostol, a prostaglandin analog, reduces acid secretion and the incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating rheumatoid arthritis. The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. Which medication schedule would the nurse teach the patient? 1. Sucralfate at bedtime and antacids before each meal 2. Sucralfate and antacids together 0 minutes before meals 3. Antacids 30 minutes before each dose of sucralfate is taken 4. Antacids after meals and sucralfate 30 minutes before meals Sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications. Which information about dietary management would the nurse include when teaching a patient with peptic ulcer disease (PUD)? 1. "You will need to remain on a bland diet." 2. "Avoid foods that cause pain after you eat them." 3. "High-protein foods are least likely to cause pain." 4. "You should avoid eating raw fruits and vegetables." The best information is that each person should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa but chewing well seems to decrease this problem and some patients tolerate these healthy foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little evidence to support their ongoing use. The nurse is assessing a patient who had a total gastrectomy 8 hours ago. Which information is most important to report to the health care provider? 1. Hemoglobin (Hgb) 10.8 g/dL 2. Temperature 102.1 F (38.9 C) 3. Absent bowel sounds in all quadrants 4. Scant nasogastric (NG) tube drainage An elevation in temperature may indicate leakage at the anastomosis, which may require return to surgery or keeping the patient NPO. The other findings are expected in the immediate postoperative period for patients who have this surgery and do not require any urgent action. A patient has just been admitted to the emergency department with nausea and vomiting. Which information requires the most rapid intervention by the nurse? 1. The patient has been vomiting for 4 days. 2. The patient takes antacids 8 to 10 times a day. 3. The patient is lethargic and difficult to arouse. 4. The patient had a small intestinal resection 2 years ago. A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information is also important to collect, but it does not require as quick action as the risk for aspiration. Which patient would the nurse assess first after receiving change-of-shift report? 1. A patient with esophageal varices who has a rapid heart rate 2. A patient with a history of gastrointestinal bleeding who has melena 3. A patient with nausea who has a dose of metoclopramide (Reglan) due 4. A patient who is crying after receiving a diagnosis of esophageal cancer A patient with esophageal varices and a rapid heart rate indicate possible hemodynamic instability caused by GI bleeding. The other patients require interventions, but their findings do not indicate acutely life-threatening complications. Which assessment would the nurse perform first for a patient who just vomited bright red blood? 1. Measuring the quantity of emesis 2. Palpating the abdomen for distention 3. Auscultating the chest for breath sounds 4. Taking the blood pressure (BP) and pulse The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume. Which prescribed action will the nurse implement first for a patient who has vomited 1100 mL of blood? 1. Give an IV H2 receptor antagonist. 2. Draw blood for type and crossmatch. 3. Administer 1 L of lactated Ringer's solution. 4. Insert a nasogastric (NG) tube and connect to suction. Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly but are not the highest priorities. The nurse is administering IV fluid boluses and nasogastric irrigation to a patient with acute gastrointestinal (GI) bleeding. Which assessment finding is most important for the nurse to communicate to the health care provider? 1. The bowel sounds are hyperactive in all four quadrants. 2. The patient's lungs have crackles audible to the midchest. 3. The nasogastric (NG) suction is returning coffee-ground material. 4. The patient's blood pressure (BP) has increased to 142/84 mm Hg. The patient's lung sounds indicate that pulmonary edema may be developing because of the rapid infusion of IV fluid and that the fluid infusion rate would be slowed. The return of coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when a patient has GI bleeding. An 80-yr-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration? 1. Sucralfate (Carafate) 2. Aluminum hydroxide 3. Omeprazole (Prilosec) 4. Metoclopramide (Reglan) Metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations. Hallucinations are not a side effect of proton pump inhibitors, mucosal protectants, or antacids. After change-of-shift report, which patient would the nurse assess first? 1. A 42-yr-old patient who has acute gastritis and ongoing epigastric pain 2. A 70-yr-old patient with a hiatal hernia who experiences frequent heartburn 3. A 60-yr-old patient with nausea and vomiting who is lethargic with dry mucosa 4. A 53-yr-old patient who has dumping syndrome after a recent partial gastrectomy A patient with nausea and vomiting who is lethargic with dry mucosa is at high risk for problems such as aspiration, dehydration, and fluid and electrolyte disturbances. The other patients will also need to be assessed, but the information about them indicates symptoms that are typical for their diagnoses and are not life threatening. A patient reports gas pains and abdominal distention 2 days after a small bowel resection. Which action would the nurse take? 1. Administer morphine sulfate. 2. Encourage the patient to ambulate. 3. Offer the prescribed promethazine. 4. Instill a mineral oil retention enema. Ambulation will improve peristalsis and help the patient eliminate flatus and reduce gas pain. A mineral oil retention enema is helpful for constipation with hard stool. A return-flow enema might be used to relieve persistent gas pains. Morphine will further reduce peristalsis. Promethazine is used as an antiemetic rather than to decrease gas pains or distention. A young adult patient is admitted to the hospital for evaluation of right lower quadrant abdominal pain with nausea and vomiting. Which action would the nurse take? 1. Assist the patient to cough and deep breathe. 2. Palpate the abdomen for rebound tenderness. 3. Suggest the patient lie on the side, flexing the right leg. 4. Encourage the patient to sip clear, noncarbonated liquids. The patient's clinical manifestations are consistent with appendicitis. Lying still with the right leg flexed is often the most comfortable position. Checking for rebound tenderness frequently is unnecessary and uncomfortable for the patient. The patient should be NPO in case immediate surgery is needed. The patient will need to know how to cough and deep breathe postoperatively, but coughing will increase pain at this time. Which finding is likely in the nurse's assessment of a patient who has a large bowel obstruction? 1. Referred back pain 2. Metabolic alkalosis 3. Projectile vomiting 4. Abdominal distention Abdominal distention is seen in lower intestinal obstruction. Referred back pain is not a common clinical manifestation of intestinal obstruction. Metabolic alkalosis is common in high intestinal obstruction because of the loss of HCl acid from vomiting. Projectile vomiting is associated with higher intestinal obstruction. Which action would the nurse plan when admitting a patient with acute diverticulitis plan for initial care? 1. Administer IV fluids. 2. Prepare for colonoscopy. 3. Encourage a high-fiber diet. 4. Give stool softeners and enemas. A patient with acute diverticulitis will be NPO and given parenteral fluids. A diet high in fiber and fluids will be implemented before discharge. Bulk-forming laxatives, rather than stool softeners, are usually given. These will be implemented later in the hospitalization. The patient with acute diverticulitis will not have enemas or a colonoscopy because of the risk for perforation and peritonitis. A patient in the emergency department has just been diagnosed with peritonitis from a ruptured diverticulum. Which prescribed intervention will the nurse implement first? 1. Send the patient for a CT scan. 2. Insert a urinary catheter to drainage. 3. Infuse metronidazole (Flagyl) 500 mg IV. 4. Place a nasogastric tube to intermittent low suction. Because peritonitis can be fatal if treatment is delayed, the initial action would be to start antibiotic therapy (after any ordered cultures are obtained). The other actions can be done after antibiotic therapy is initiated. A patient calls the clinic reporting diarrhea for 24 hours. Which action would the nurse take first? 1. Inform the patient that testing of blood and stools will be needed. 2. Suggest that the patient drink clear liquid fluids with electrolytes. 3. Ask the patient to describe the stools and any associated symptoms. 4. Advise the patient to use over-the-counter antidiarrheal medication. The initial response by the nurse should be further assessment of the patient. The other responses may be appropriate, depending on what is learned in the assessment. A patient is admitted to the emergency department with severe abdominal pain and rebound tenderness. Vital signs include temperature 102 F (38.3 C), pulse 120 beats/min, respirations 32 breaths/min, and blood pressure (BP) 82/54 mm Hg. Which prescribed intervention would the nurse implement first? 1. Administer IV ketorolac 15 mg for pain relief. 2. Send a blood sample for a complete blood count (CBC). 3. Infuse a liter of lactated Ringer's solution over 30 minutes. 4. Send the patient for an abdominal computed tomography (CT) scan. The priority for this patient is to treat the patient's hypovolemic shock with fluid infusion. The other actions should be implemented after starting the fluid infusion. Which patient would the nurse assess first after receiving change-of-shift report? 1. A 40-yr-old patient who has a distended abdomen and tachycardia 2. A 60-yr-old patient whose ileostomy has drained 800 mL over 8 hours 3. A 30-yr-old patient with ulcerative colitis who had six liquid stools in 4 hours 4. A 50-yr-old patient with familial adenomatous polyposis who has occult blood in the stool The patient's abdominal distention and tachycardia suggest hypovolemic shock caused by problems such as peritonitis or intestinal obstruction, which will require rapid intervention. The other patients would be assessed as quickly as possible, but the data do not indicate any life-threatening complications associated with their diagnoses. A 76-yr-old patient with obstipation has a fecal impaction and is incontinent of liquid stool. Which action would the nurse take first? 1. Administer bulk-forming laxatives. 2. Assist the patient to sit on the toilet. 3. Manually remove the hard stool. 4. Increase the patient's oral fluid intake. The initial action with a fecal impaction is manual disimpaction. The other actions will be used to prevent future constipation and impactions. A patient is awaiting surgery for acute peritonitis. Which action will the nurse plan to include in the preoperative care? 1. Position patient with the knees flexed. 2. Avoid use of opioids or sedative drugs. 3. Offer frequent small sips of clear liquids. 4. Assist patient to breathe deeply and cough. There is less peritoneal irritation with the knees flexed, which will help decrease pain. Opioids and sedatives are typically given to control pain and anxiety. Preoperative patients with peritonitis are given IV fluids for hydration. Deep breathing and coughing will increase the patient's discomfort. Which menu choice by the patient with diverticulosis is best for preventing diverticulitis? 1. Navy bean soup and vegetable salad 2. Whole grain pasta with tomato sauce 3. Baked potato with low-fat sour cream 4. Roast beef sandwich on whole wheat bread A diet high in fiber and low in fats and red meat is recommended to prevent diverticulitis. Although all the choices have some fiber, the bean soup and salad will be the highest in fiber and the lowest in fat. A young woman with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. Which information will the nurse add to a teaching plan about UTIs for this patient that goes beyond a general teaching plan for UTIs? 1. Fistulas can form between the bowel and bladder. 2. Bacteria in the perianal area can enter the urethra. 3. Drink adequate fluids to maintain normal hydration. 4. Empty the bladder before and after sexual intercourse. Fistulas between the bowel and bladder occur in Crohn's disease and can lead to UTI. Teaching for UTI prevention in general includes good hygiene, adequate fluid intake, and voiding before and after intercourse. Which information will the nurse include in teaching a patient who had a proctocolectomy and ileostomy for ulcerative colitis? 1. Restrict fluid intake to prevent constant liquid drainage from the stoma. 2. Use care when eating high-fiber foods to avoid obstruction of the ileum. 3. Irrigate the ileostomy daily to avoid having to wear a drainage appliance. 4. Change the pouch every day to prevent leakage of contents onto the skin. High-fiber foods are introduced gradually and should be well chewed to avoid obstruction of the ileostomy. Patients with ileostomies do not have a colon for the absorption of water; they need to take in increased amounts of fluid. The pouch should be drained frequently but is changed every 5 to 7 days. The drainage from an ileostomy is liquid and continuous, so control by irrigation is not possible. A young adult contracts hepatitis from contaminated food. Which result would the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient's illness? 1. Antibody to hepatitis D (anti-HDV) 2. Hepatitis B surface antigen (HBsAg) 3. Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG) 4. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM) Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity. The nurse evaluates that administration of hepatitis B vaccine to a healthy patient was effective when the patient's later blood specimen reveals the presence of 1. HBsAg. 2. anti-HBs. 3. anti-HBc IgG. 4. anti-HBc IgM. The presence of surface antibody to hepatitis B (anti-HBs) is a marker of a positive response to the vaccine or previous illness with hepatitis B. The other laboratory values indicate current infection with hepatitis B. A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action would the nurse take? 1. Schedule the patient for HCV genotype testing. 2. Administer the HCV vaccine and immune globulin. 3. Teach the patient about direct-acting antiviral treatment. 4. Explain that the infection will resolve over a few months. Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated. Because most patients with acute HCV infection convert to the chronic state, the nurse should not teach the patient that the HCV will resolve in a few months. Immune globulin or vaccine is not available for HCV. Direct-acting antiviral drugs are used for chronic HCV infection. Which topic would the nurse plan to teach the patient diagnosed with acute hepatitis B? 1. Administering a-interferon 2. Measures for improving appetite 3. Side effects of nucleotide analogs 4. Ways to increase activity and exercise Maintaining adequate nutritional intake is important for regeneration of hepatocytes. Interferon and antivirals may be used for chronic hepatitis B, but they are not prescribed for acute hepatitis B infection. Rest is recommended. Which information from a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? 1. The patient had a blood transfusion in 2005. 2. The patient used IV drugs about 30 years ago. 3. The patient frequently eats in fast-food restaurants. 4. The patient traveled to a country with poor sanitation.