Exam 4: PRN1178/ PRN 1178 (New 2026/ 2027 Update) Client-Centered Care II Review| Complete Question & Answer| 100% Correct| A Grade - Rasmussen

Exam 4: PRN1178/ PRN 1178 (New 2026/ 2027 Update) Client-Centered Care II Review| Complete Question & Answer| 100% Correct| A Grade - Rasmussen Q. A patient with a history of peptic ulcer disease has presented to the emergency department with severe abdominal pain and a rigid, boardlike abdomen. The health care provider suspects a perforated ulcer. Which interventions should the nurse anticipate? ANSWER Providing IV fluids and inserting a nasogastric (NG) tube Administering oral bicarbonate and testing the patient's gastric pH level Performing a fecal occult blood test and administering IV calcium gluconate Starting parenteral nutrition and placing the patient in a high-Fowler's position Providing IV fluids and inserting a nasogastric (NG) tube Q. After administration of a dose of metoclopramide, which patient assessment finding would show the medication was effective? ANSWER Decreased blood pressure Absence of muscle tremors Relief of nausea and vomiting No further episodes of diarrhea Relief of nausea and vomiting Q. The nurse determines a patient has experienced the beneficial effects of therapy with famotidine when which symptom is relieved? ANSWER Nausea Belching Epigastric pain Difficulty swallowing Epigastric pain -H2 blocker Q. A patient who had a gastroduodenostomy (Billroth I operation) for stomach cancer reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating. What long-term complication does the nurse suspect is occurring? ANSWER Malnutrition Bile reflux gastritis Dumping syndrome Postprandial hypoglycemia Dumping syndrome Q. The nurse is caring for a patient treated with IV fluid therapy for severe vomiting. As the patient recovers and begins to tolerate oral intake, which food choice would be most appropriate? ANSWER Iced tea Dry toast Hot coffee Plain yogurt Dry toast Q. A patient complaining of nausea receives a dose of metoclopramide. Which potential adverse effect should the nurse tell the patient to report? ANSWER Tremors Constipation Double vision Numbness in fingers and toes Tremors Q. The nurse is caring for a patient who complains of abdominal pain and hematemesis. Which new assessment finding(s) would indicate the patient is experiencing a decline in condition? ANSWER Pallor and diaphoresis Ecchymotic peripheral IV site Guaiac-positive diarrhea stools Heart rate 90, respiratory rate 20, BP 110/60 Pallor and diaphoresis Q. A patient was admitted with epigastric pain because of a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care? ANSWER Back pain 3 or 4 hours after eating a meal Chest pain relieved with eating or drinking water Burning epigastric pain 90 minutes after breakfast Rigid abdomen and vomiting following indigestion Rigid abdomen and vomiting following indigestion Q. The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO. The nurse will determine the medication was effective when which symptom has been resolved? ANSWER Diarrhea Heartburn Constipation Lower abdominal pain Heartburn Q. The patient with chronic gastritis is being put on a combination of medications to eradicate Helicobacter pylori. Which drugs does the nurse know will probably be used? ANSWER Antibiotic(s), antacid, and corticosteroid Antibiotic(s), aspirin, and antiulcer/protectant Antibiotic(s), proton pump inhibitor, and bismuth Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs) Antibiotic(s), proton pump inhibitor, and bismuth Q. A patient with oral cancer is not eating. A small-bore feeding tube was inserted and the patient started on enteral feedings. Which patient goal would indicate improvement? ANSWER Weight gain of 1 kg in 1 week Administer tube feeding at 25 mL/hr. Consume 50% of clear liquid tray this shift. Monitor for tube for placement and gastrointestinal residual. Weight gain of 1 kg in 1 week Q. A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient? ANSWER Barium swallow Endoscopic biopsy Capsule endoscopy Endoscopic ultrasonography Endoscopic biopsy *this is likely cancer Q. A 74-yr-old female patient with osteoporosis is diagnosed with gastroesophageal reflux disease (GERD). Which over-the-counter medication to treat GERD should be used with caution? ANSWER Sucralfate Cimetidine Omeprazole Metoclopramide Omeprazole *Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine. Q. The patient is having an esophagoenterostomy with anastomosis of a segment of the colon to replace the resected portion. What initial postoperative care should the nurse expect when this patient returns to the nursing unit? ANSWER Turn, deep breathe, cough, and use spirometer every 4 hours. Maintain an upright position for at least 2 hours after eating. NG will have bloody drainage and it should not be repositioned. Keep in a supine position to prevent movement of the anastomosis. NG will have bloody drainage and it should not be repositioned. Q. The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which teaching point should the nurse provide to the patient based on this new diagnosis? ANSWER "It would be beneficial for you to eliminate drinking alcohol." "You'll need to drink at least two to three glasses of milk daily." "Many people find that a minced or pureed diet eases their symptoms of PUD." "Taking medication will allow you to keep your present diet while minimizing symptoms." "It would be beneficial for you to eliminate drinking alcohol." Meds that relax Lower Esophageal Sphincter? (SATA) Nitrates CCB Diazepam Anticholinergics Nitrates CCB Diazepam Anticholinergics Calcium carbonate, aluminum hydroxide and magnesium hydroxide are: Antacids H2 blockers PPIs Antacids (take 1 hr from other meds) (Neutralize acid secretion) Ranitidine, Famotidine, and Nizatidine are: Antacids H2 blockers PPIs H2 blockers (take with meals and at night) (Inhibits acid secretion) Omeprazole, lansoprazole, and rabeprazole are: Antacids H2 blockers PPIs PPIs (take on empty stomach) (inhibits acid secretion) (most effective with GERD) (long term use can r/i fractures) Sucralfate is an antiulcer agent -coats stomach lining Metoclopramide promotes peristalsis Octreotide is given sub-q and can be given to block gastric and pancreatic hormones to help treat _______________ syndrome dumping A nurse is caring for a client who has a new dx of GERD. The nurse should anticipate prescriptions for which of the following (SATA) Antacids H2 blockers Opioid analgesics Fiber laxatives PPIs Antacids H2 blockers PPIs The nurse is reviewing nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices can trigger cholecystitis? Brownie w/ nuts Bowl of mixed fruit Grilled turkey Baked potato brownie with nuts (high fat) A nurse is completing discharge teaching to a client who is postop following a fundoplication. Which of the following statements made by the client indicates understanding of the teaching? "When sitting in my lounge chair after a meal, I will lower the back of it "I will try to eat 3 large meals a day "I will elevate the head of my bed on blocks "When sleeping, I will lay on my left side "I will elevate the head of my bed on blocks A nurse is teaching a client who has a dx of dumping syndrome following gastric surgery. Which of the following info should the nurse include? Eat 3 moderate-sized meals a day Drink at least 1 glass of water with each meal Eat a bedtime snack that contains a milk product Increase protein in diet increase protein in diet -eat small meals, don't drink with meals A nurse in the ER is completing an assessment of a client who has suspected stomach perforation d/t a peptic ulcer. Which of the following findings should the nurse expect? (SATA): Rigid abdomen Tachycardia Elevated BP Circumoral cyanosis Rebound tenderness rigid abdomen tachycardia rebound tenderness (primary concern for this pt? hypovolemic shock) A nurse is completing assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (SATA) Pain relieved by eating Pain at night Bloating sensation Pain upon palpation of epigastric region Pain 30 min to 1 hr after a meal Bloating sensation Pain upon palpation of epigastric region Pain 30 min to 1 hr after a meal A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following info should the nurse include in the teaching (SATA). Take med 1 hr before a meal Limit NSAIDs when taking this med Expect skin flushing Increase fiber Chew med Take med 1 hr before a meal Limit NSAIDs when taking this med Pre-albumin normal levels 20 -severe: less than 5 -best indicator of nutrition albumin normal levels 3.5-5.5 -severe: less than 2.5 Total lymphocyte count norm 2,500 severe: less than 800 -when proteins decrease, body lacks lymphocytes and increase r/f infection Serum Transferrin ___ in protein deficiency decreases RBC and Hgb ____ in protein deficiency decrease Hgb normal levels 11.7-17.3 Which electrolytes are imbalanced when there is a protein deficiency? calcium / potassium (low) LIver enzymes ____ during a protein deficiency increase Megastrol and Marinol Appetite stimulants Best way for a nurse to confirm placement of a small bore NG tube after feeding is by: xray The nurse aspirates 220 mL of gastric contents from the PEG tube before giving bolus tube feeding. The nurse should: Rtn aspirate to stomach and recheck volume in one hour Rtn aspirate to stomach and continue with tube feeding Discard aspirate to prevent overdistending stomach Notify PCP that feedings have been scheduled too frequently to allow for stomach emptying Rtn aspirate to stomach and continue with tube feeding -Hold at 250 mL -PEG tube = Enteral Nutrition (functioning GI tract)/long term -Kangaroo Pump A client receiving TPN requests that the nurse DC the TPN infusion so he can take a shower. What is the best response? Contact PCP to get an appropriate order DC TPN but emphasize the need to notify the nurse to reconnect ASAP Increase rate for an hour to compensate for the time the line will be off Explain the request cannot be met with rationale Explain the request cannot be met with rationale -hypoglycemic episode -TPN: Parenteral nutrition, vein, no functioning GI tract, central line, able to handle glucose 20-50%, longterm The nurse is caring for a patient receiving 1000 mL of PN over 24 hours. When it is time to change the solution, 150 mL remain in the bottle. What does the nurse do? Hang new solution and discard unused solution -risk for bacterial growth -change tubing/filter ever 24 hours Decreases peristalsis, increases bulk: Loperamide Psyllium Alosetron Lubiprostone Loperamide -anti-diarrhea bulk-forming laxative: Loperamide Psyllium Alosetron Lubiprostone Psyllium -anti-diarrheal Increases firmness of stool, for women w/ IBS: Loperamide Psyllium Alosetron Lubiprostone Alosetron -anti-diarrheal Promotes intestinal motility, for women with IBS: Loperamide Psyllium Alosetron Lubiprostone Lubiprostone -anti-constipation Increases fluid and motility in intestines: Loperamide Psyllium Linaclotide Lubiprostone Linaclotide -anti-constipation Sulfasalazine sulfonamides -allergies -2-4 wks for full effect -CBC for anemia Mesalamine nonsulfonamides -BUN, Crt -also balsalzide Balsalzide nonsulfonamides -BUN, Crt -also: mesalamine Prednisone, Prednisolone, Hydrocortisone corticosteroids -decrease pain/inflammation -SE: slow healing, water wt, high risk for infection Immunomodulators Infliximab, adalimumab -suppress immune response Immunosuppressants (SATA) Infliximab Cyclosporine Methotrexate Azathioprine Adalimumab Cyclosporine Azathioprine Methotrexate A person on Sulfasalazine, a sulfonamide may need which supplement? Iron B12 Folic Acid Calcium folic acid A patient on corticosteroids may need which supplement? Iron B12 Folic acid Calcium calcium -can cause osteoporosis When given Havrix for Hep A, it requires 2 doses. Take one now and another one in: 6-12 months When giving Immune Globulins for Hep A, it provides passive immunity for 1-2 months. This should be given before or within ___ after exposure 2 weeks When given the vaxx for Hep B, it takes 3 doses. Take one now, then another in ___ month(s), and the last one ____ month(s) from the first dose. 1; 6 When given the Immune globin for Hep B, it provides passive immunity for post exposure prevention. Take this within ____ of exposure. 24 hours Avoid ___________________ and _______________ when you have suspected hepatitis alcohol acetaminophen A patient who cannot afford enough food for her family states she only eats after her children have eaten. At a clinic visit, she reports bleeding gums; loose teeth; and dry, itchy skin. Which vitamin deficiency would the nurse suspect? Folic acid Vitamin C Vitamin D Vitamin K Vitamin C After identifying that a patient has possible nutritional deficits, which action will the nurse perform next? Provide supplements between meals. Encourage eating meals with others. Have family bring in food from home. Complete a full nutritional assessment. Complete a full nutritional assessment. The nurse is providing care for a patient who is a strict vegetarian. Which dietary choices would the nurse recommend to prevent iron deficiency? Brown rice and kidney beans Cauliflower and egg substitutes Soybeans and hot breakfast cereal Whole-grain bread and citrus fruits Soybeans and hot breakfast cereal The patient has parenteral nutrition (PN) infusing with amino acids and dextrose. During shift change, the nurse reports the tubing, bag, and dressing were changed 20 hours ago. What care should the incoming nurse plan to deliver (select all that apply.)? Select all that apply. Giving the patient insulin if needed Ensuring that the next bag has been ordered Checking amount of solution left in the bag Assessing the insertion site and change the tubing Verifying the accuracy of the new solution and ingredients Giving the patient insulin if needed Ensuring that the next bag has been ordered Checking amount of solution left in the bag Verifying the accuracy of the new solution and ingredients A patient who has sustained severe burns in a motor vehicle accident is starting parenteral nutrition (PN). Which principle should guide the nurse's administration of PN? Administration of PN requires clean technique. Central PN requires rapid dilution in a large volume of blood. Peripheral PN delivery is preferred over the use of a central line. Only water-soluble medications may be added to the PN by the nurse. Central PN requires rapid dilution in a large volume of blood. A patient who has dysphagia after a stroke is receiving enteral feedings through a percutaneous endoscopic gastrostomy (PEG). What intervention should the nurse integrate into the plan of care? Use 30 mL of normal saline to flush the tube every 4 hours. Avoid flushing the tube any time the patient is receiving continuous feedings. Flush the tube before and after feedings if the patient's feedings are intermittent. Flush the PEG with 100 mL of sterile water before and after medication administration. Flush the tube before and after feedings if the patient's feedings are intermittent. A patient who is unable to swallow because of progressive amyotrophic lateral sclerosis is prescribed enteral nutrition through a newly placed gastrostomy tube. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? Irrigate the tube between feedings. Provide wound care at the gastrostomy site. Administer prescribed liquid medications through the tube. Position the patient with a 45-degree head of bed elevation. Position the patient with a 45-degree head of bed elevation. The stable patient has a gastrostomy tube for enteral feeding. Which care could the RN delegate to the LPN (select all that apply.)? Select all that apply. Administer bolus or continuous feedings. Evaluate the nutritional status of the patient. Administer medications through the gastrostomy tube. Monitor for complications related to the tube and enteral feeding. Teach the caregiver about feeding via the gastrostomy tube at home. Administer bolus or continuous feedings. Administer medications through the gastrostomy tube. A frail older adult with recent severe weight loss is instructed to eat a high-protein, high-calorie diet at home. Which foods would the nurse suggest for breakfast? Orange juice and dry toast Oatmeal with butter and cream Waffles with fresh strawberries Banana and unsweetened yogurt Oatmeal with butter and cream A malnourished patient has been diagnosed with protein deficiency. Which complications should the nurse anticipate (select all that apply.)? Select all that apply. Edema Asthma Anemia Malabsorption syndrome Impaired wound healing Gastrointestinal bleeding Edema Anemia Impaired wound healing The nurse is teaching a patient with type 1 diabetes mellitus who had surgery to revise a lower leg stump with a skin graft about nutrition. What food should the nurse teach the patient to eat to best facilitate healing? Nonfat milk Chicken breast Fortified oatmeal Olive oil and nuts Chicken breast A patient received a small-bore nasogastric (NG) tube after a laryngectomy. Which action has the highest priority before initiating enteral feedings? Testing aspirated fluid pH Auscultating while instilling air Elevating head of bed to 40 degrees Verifying NG tube placement on x-ray Verifying NG tube placement on x-ray Facilitating the nutritional status of a patient early in the starvation cycle is important. In what order do the following events occur in starvation? a. Body fat is mobilized to supply energy. b. Skeletal proteins are converted to glucose for energy. c. Body or visceral proteins are broken down to supply glucose. d. Glycogen stores in liver and muscle are broken down to glucose. d. Glycogen stores in liver and muscle are broken down to glucose. b. Skeletal proteins are converted to glucose for energy. a. Body fat is mobilized to supply energy. c. Body or visceral proteins are broken down to supply glucose. A patient was admitted with a fractured hip after being found on the floor of her home. She was extremely malnourished and started on parenteral nutrition (PN) 3 days ago. Which assessment finding would be of most concern to the nurse? Blood glucose level of 125 mg/dL Serum phosphate level of 1.9 mg/dL White blood cell count of 10,500/μL Serum potassium level of 4.6 mEq/L Serum phosphate level of 1.9 mg/dL The nurse is evaluating the nutritional status of a patient undergoing radiation treatment for oropharyngeal cancer. Which laboratory test would best indicate the patient has protein-calorie malnutrition (PCM)? Serum transferrin Serum prealbumin C-reactive protein (CRP) Alanine transaminase (ALT) Serum prealbumin -20 severe: less than 5 A patient is admitted with anorexia nervosa and a serum potassium level of 2.4 mEq/L. What complication is most important for the nurse to observe for in this patient? Muscle weakness Cardiac dysrhythmias Increased urine output Anemia and leukopenia Cardiac dysrhythmias Which focused assessments would have priority in the care of a patient recently started on parenteral nutrition (PN)? Skin integrity and skin turgor Electrolyte levels and daily weights Auscultation of lung and bowel sounds Peripheral edema and level of consciousness Electrolyte levels and daily weights A patient is being admitted with anorexia nervosa. Which clinical manifestations should the nurse anticipate? Sensitivity to heat, fatigue, and polycythemia Hair loss; dry, yellowish skin; and constipation Tented skin turgor, hyperactive reflexes, and diarrhea Dysmenorrhea, hypoactive bowel sounds, and hunger Hair loss; dry, yellowish skin; and constipation The nurse is reviewing the laboratory test results for a patient with metastatic lung cancer who was admitted with a diagnosis of malnutrition. The serum albumin level is 4.0 g/dL, and prealbumin is 10 mg/dL. How will the nurse interpret these results? The albumin level is normal therefore the patient does not have protein malnutrition. The albumin level is increased, which is common in patients with cancer who have malnutrition. Both the serum albumin and prealbumin levels are reduced, consistent with the diagnosis of malnutrition. Although the serum albumin level is normal, the prealbumin level more accurately reflects the patient's nutritional status. Although the serum albumin level is normal, the prealbumin level more accurately reflects the patient's nutritional status. Pre-albumin: 20 Albumin: 3.8-4.5 After an exploratory laparotomy, a patient on a clear liquid diet reports severe gas pains and abdominal distention. Which action by the nurse is most appropriate? Return the patient to NPO status. Place cool compresses on the abdomen. Encourage the patient to ambulate as ordered. Administer an as-needed dose of IV morphine sulfate. Encourage the patient to ambulate as ordered. The nurse is preparing to administer famotidine to a postoperative patient with a colostomy. The patient states they do not have heartburn. What response by the nurse would be the most appropriate? "It will reduce the amount of acid in the stomach." "It will prevent air from accumulating in the stomach, causing gas pains." "It will prevent the heartburn that occurs as a side effect of general anesthesia." "The stress of surgery is likely to cause stomach bleeding if you do not receive it." "It will reduce the amount of acid in the stomach." Which clinical manifestations of inflammatory bowel disease does the nurse determine are common to both patients with ulcerative colitis (UC) and Crohn's disease (select all that apply.)? Select all that apply. Restricted to rectum Strictures are common Bloody, diarrhea stools Cramping abdominal pain Lesions penetrate intestine Strictures are common Bloody, diarrhea stools Cramping abdominal pain The wound, ostomy, and continence nurse (WOCN) selects the site where the ostomy will be placed. What should be included in site consideration? The patient must be able to see the site. The site should be outside the rectus muscle area. It is easier to seal the drainage bag to a protruding area. A waistline site will allow using a belt to hold the appliance in place. The patient must be able to see the site. The nurse is preparing to administer a dose of bisacodyl to a patient with constipation and the patient asks how it will work. What is the best response by the nurse? "It will increase bulk in the stool." "It will lubricate the intestinal tract to soften feces." "It will increase fluid retention in the intestinal tract." "It will increase peristalsis by stimulating nerves in the colon wall." "It will lubricate the intestinal tract to soften feces." The nurse should administer an as-needed dose of magnesium hydroxide after noting what information when reviewing a patient's medical record? Abdominal pain and bloating No bowel movement for 3 days A decrease in appetite by 50% over 24 hours Muscle tremors and other signs of hypomagnesemia No bowel movement for 3 days The nurse is administering a cathartic agent to a patient with renal insufficiency. Which order will the nurse question? Bisacodyl Lubiprostone Cascara sagrada Magnesium hydroxide Lubiprostone When evaluating the patient's understanding about the care of the ileostomy, which statement by the patient indicates the patient needs more teaching? "I will be able to regulate when I have stools." "I will be able to wear the pouch until it leaks." "The drainage from my stoma can damage my skin." "Dried fruit and popcorn must be chewed very well." "The drainage from my stoma can damage my skin." The nurse is caring for a patient admitted with a suspected bowel obstruction. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient's clinical picture? Low-pitched and rumbling above the area of obstruction High-pitched and hypoactive below the area of obstruction Low-pitched and hyperactive below the area of obstruction High-pitched and hyperactive above the area of obstruction Low-pitched and rumbling above the area of obstruction A colectomy is scheduled for a patient with ulcerative colitis. The nurse should plan to include which prescribed measure in the preoperative preparation of this patient? Instruction on irrigating a colostomy Administration of a cleansing enema A high-fiber diet the day before surgery Administration of IV antibiotics for bowel preparation Administration of IV antibiotics for bowel preparation The nurse is preparing to administer a scheduled dose of docusate sodium when the patient reports an episode of loose stool and does not want to take the medication. What is the appropriate action by the nurse? Write an incident report about this untoward event. Attempt to have the family convince the patient to take the ordered dose. Withhold the medication at this time and try to administer it later in the day. Chart the dose as not given on the medical record and explain in the nursing progress notes. Chart the dose as not given on the medical record and explain in the nursing progress notes. The nurse is preparing to administer a daily dose of docusate sodium to a patient that will continue taking it after discharge. What information should the nurse provide to the patient to optimize the outcome of the medication? Take a dose of mineral oil at the same time. Add extra salt to food on at least one meal tray. Ensure a dietary intake of 10 g of fiber each day. Take each dose with a full glass of water or other liquid. Take each dose with a full glass of water or other liquid. A patient is planned for discharge home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member? A nursing assistant on the unit who also has hospice experience A licensed practical nurse that has worked on the unit for 10 years A registered nurse with 6 months of experience on the surgical unit A registered nurse who has floated to the surgical unit from pediatrics A registered nurse with 6 months of experience on the surgical unit Don't delegate what you EAT A patient with suspected bowel obstruction had a nasogastric tube inserted at 4:00 AM. The nurse shares in the morning report that the day shift staff should check the tube for patency at what times? 7:00 AM, 10:00 AM, and 1:00 PM 8:00 AM, 12:00 PM, and 4:00 PM 9:00 AM and 3:00 PM 9:00 AM, 12:00 PM, and 3:00 PM 8:00 AM, 12:00 PM, and 4:00 PM The nurse is preparing to insert a nasogastric (NG) tube into a patient with a suspected small intestinal obstruction that is vomiting. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate? "The tube will help to drain the stomach contents and prevent further vomiting." "The tube will push past the area that is blocked and thus help to stop the vomiting." "The tube is just a standard procedure before many types of surgery to the abdomen." "The tube will let us measure your stomach contents so we can give you the right IV fluid replacement." "The tube will help to drain the stomach contents and prevent further vomiting." The nurse requests a patient scheduled for colectomy to sign the operative permit as directed in the physician's preoperative orders. The patient states that the physician has not really explained very well what is involved in the surgical procedure. What is the most appropriate action by the nurse? Ask family members whether they have discussed the surgical procedure with the physician. Have the patient sign the form and state the physician will visit to explain the procedure before surgery. Explain the planned surgical procedure as well as possible and have the patient sign the consent form. Delay the patient's signature on the consent and notify the physician about the conversation with the patient. Delay the patient's signature on the consent and notify the physician about the conversation with the patient. What information would have the highest priority for the nurse to include in preoperative teaching for a patient scheduled for a colectomy? How to care for the wound How to deep breathe and cough The location and care of drains after surgery Which medications will be used during surgery How to deep breathe and cough The nurse identifies that which patient is at highest risk for developing colon cancer? A 28-yr-old man who has a body mass index of 27 kg/m2 A 32-yr-old woman with a 12-year history of ulcerative colitis A 52-yr-old man who has followed a vegetarian diet for 24 years A 58-yr-old woman taking prescribed estrogen replacement therapy A 32-yr-old woman with a 12-year history of ulcerative colitis When teaching the patient about the diet for diverticular disease, which foods should the nurse recommend? White bread, cheese, and green beans Fresh tomatoes, pears, and corn flakes Oranges, baked potatoes, and raw carrots Dried beans, All Bran (100%) cereal, and raspberries Dried beans, All Bran (100%) cereal, and raspberries A patient with an intestinal obstruction has a nasogastric (NG) tube to suction but complains of nausea and abdominal distention. The nurse irrigates the tube as necessary as ordered, but the irrigating fluid does not return. What should be the priority action by the nurse? Notify the physician. Auscultate for bowel sounds. Reposition the tube and check for placement. Remove the tube and replace it with a new one. Reposition the tube and check for placement. The nurse is admitting a patient with severe dehydration and frequent watery diarrhea. A 10-day outpatient course of antibiotic therapy for bacterial pneumonia has just been completed. What is the most important for the nurse to take which action? Wear a mask to prevent transmission of infection. Wipe equipment with ammonia-based disinfectant. Instruct visitors to use the alcohol-based hand sanitizer. Don gloves and gown before entering the patient's room. Don gloves and gown before entering the patient's room. The nurse is developing a plan of care for a patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history does the nurse recognize as increasing the patient's risk for colorectal cancer? Osteoarthritis History of colorectal polyps History of lactose intolerance Use of herbs as dietary supplements History of colorectal polyps A patient is admitted to the emergency department after a motor vehicle crash with suspected abdominal trauma. What assessment finding by the nurse is of highest priority? Nausea and vomiting Hyperactive bowel sounds Firmly distended abdomen Abrasions on all extremities Firmly distended abdomen Two days after a colectomy for an abdominal mass, a patient reports gas pains and abdominal distention. The nurse plans care for the patient based on the knowledge that the symptoms are occurring as a result what event? Impaired peristalsis Irritation of the bowel Nasogastric suctioning Inflammation of the incision site Impaired peristalsis *Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastrointestinal motility, leading to gas pains and abdominal distention. The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation? Maintain a high intake of fluid and fiber in the diet. Discontinue intake of medications causing constipation. Eat several small meals per day to maintain bowel motility. Sit upright during meals to increase bowel motility by gravity. Maintain a high intake of fluid and fiber in the diet. The nurse is preparing a patient for a capsule endoscopy. What should the nurse ensure is included in the preparation? Ensure the patient understands the required bowel preparation. Have the patient return to the procedure room for removal of the capsule. Teach the patient to maintain a clear liquid diet throughout the procedure. Explain to the patient that conscious sedation will be used during capsule placement. Ensure the patient understands the required bowel preparation. A patient reports severe pain when the nurse assesses for rebound tenderness. What may this assessment finding indicate? Hepatic cirrhosis Hypersplenomegaly Gallbladder distention Peritoneal inflammation Peritoneal inflammation The nurse should recognize that the liver performs which functions (select all that apply.)? Select all that apply. Bile storage Detoxification Protein metabolism Steroid metabolism Red blood cell (RBC) destruction Detoxification Protein metabolism Steroid metabolism Red blood cell (RBC) destruction The nurse is reviewing the home medication list for a patient admitted with suspected hepatic failure. Which medication reviewed by the nurse could cause hepatotoxicity? Digoxin Nitroglycerin Ciprofloxacin Acetaminophen Acetaminophen Inspection of an older patient's mouth reveals the presence of white, curd-like lesions on the patient's tongue. What does the nurse recognize is the most likely etiology for this abnormal assessment finding? Herpesvirus Candida albicans Vitamin deficiency Irritation from ill-fitting dentures Candida albicans A patient with a family history of adenomatous polyposis had a colonoscopy with removal of multiple polyps. Which signs and symptoms should the nurse teach the patient to report immediately? Fever and abdominal pain Flatulence and liquid stool Loudly audible bowel sounds Sleepiness and abdominal cramps Fever and abdominal pain The nurse is performing a focused abdominal assessment of a patient who has been recently admitted. In order to palpate the patient's liver, where should the nurse palpate the patient's abdomen? Left lower quadrant Left upper quadrant Right lower quadrant Right upper quadrant Right upper quadrant A patient with abdominal pain is being prepared for surgery to make an incision into the common bile duct to remove stones. What procedure will the nurse prepare the patient for? Colectomy Cholecystectomy Choledocholithotomy Choledochojejunostomy Choledocholithotomy *A choledocholithotomy is an opening into the common bile duct for the removal of stones. *A colectomy is the removal of the colon. *The cholecystectomy is the removal of the gallbladder. *The choledochojejunostomy is an opening between the common bile duct and jejunum. A patient is scheduled for a percutaneous transhepatic cholangiography to restore biliary drainage. The nurse discusses the patient's health history and is most concerned if the patient makes which statement? "I am allergic to bee stings." "My tongue swells when I eat shrimp." "I have had epigastric pain for 2 months." "I have a pacemaker because my heart rate was slow." "My tongue swells when I eat shrimp." The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobulin (IG) injection? A caregiver who lives in the same household with the patient A friend who delivers meals to the patient and family each week A relative with a history of hepatitis A who visits the patient daily A child living in the home who received the hepatitis A vaccine 3 months ago A caregiver who lives in the same household with the patient A patient with hepatitis B surface antigen (HBsAg) present in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question? Tramadol Hydromorphone (Dilaudid) Oxycodone with aspirin (Percodan) Hydrocodone with acetaminophen Hydrocodone with acetaminophen When teaching the patient with acute hepatitis C (HCV), which statement demonstrates understanding of the disease process? "I will use care when kissing my wife to prevent giving it to her." "I will need to take adefovir (Hepsera) to prevent chronic HCV." "Now that I have had HCV, I will have immunity and not get it again." "I will need to be monitored for chronic HCV and other liver problems." "I will need to be monitored for chronic HCV and other liver problems." The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which response by the nurse is most appropriate? "You will need to be tested first; then treatment can be determined." "The hepatitis vaccine will provide immunity from this and future exposures." "There is nothing you can do since the patient was infectious before admission." "An immunoglobulin injection will be given to prevent infection or limit symptoms." "An immunoglobulin injection will be given to prevent infection or limit symptoms." The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What is the nurse's priority? Prevent all oral intake. Control abdominal pain. Provide enteral feedings. Avoid dietary cholesterol. Control abdominal pain. *Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis. When providing discharge teaching for a patient after a laparoscopic cholecystectomy, what information should the nurse include? Do not return to work or normal activities for 3 weeks. A lower-fat diet may be better tolerated for several weeks. Bile-colored drainage will probably drain from the incision. Keep the bandages on and the puncture site dry until it heals. A lower-fat diet may be better tolerated for several weeks. In what order does the body use substrates for energy for starvation? Carbohydrates Skeletal Protein Fat Stores Visceral Protein A patient is receiving Peripheral Parenteral Nutrition. The parenteral nutrition solution is completed before the new solution arrives on the unit. The nurse gives: 20% intralipids 5% dextrose solution 0.45% normal saline solution 5% lactated Ringer's solution 5% dextrose Which instructions would the nurse include in the teaching plan for a pt with mild GERD? "The best time to take an as-needed antacid is 1 to 3 hours after meals "A glass of warm milk at bedtime will decrease your discomfort at night "Do not chew gum; the excess saliva will cause you to secrete more acid "Limit your intake of foods high in protein because they take longer to digest "The best time to take an as-needed antacid is 1 to 3 hours after meals T/F The nurse is teaching a client that peptic ulcers are promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol true Assessment findings suggestive of peritonitis include (SATA): Rebound tenderness Soft, distended abdomen Dull, intermittent abdominal pain Shallow respirations w/ bradypnea Observing that the pt is lying still Rebound tenderness Observing that the pt is lying still In planning care for the patient with Crohn's disease, the nurse recognizes that a major difference between Ulcerative Colitis and Crohn's disease is that Crohn's disease: frequently results in toxic megacolon causes fewer nutritional deficiencies than UC often recurs after surgery, whereas UC is curable with a colectomy is manifested by rectal bleeding and anemia more often than UC often recurs after surgery, whereas UC is curable with a colectomy The nurse performs assessment of the abdomen of a pt with a possible bowel obstruction, knowing that manifestations of a bowel obstruction are (SATA) persistent abdominal pain marked abdominal distention diarrhea that is loose or liquid colicky, severe, intermittent pain profuse vomiting that relieves abdominal pain persistent abdominal pain marked abdominal distention In contrast to diverticulitis, the patient with diverticulosis has rectal bleeding often has no symptoms has localized cramping pain frequently develops peritonitis often has no symptoms a patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that: Pruritus is a common problem with jaundice in this phase The patient is likely to transmit the disease during this phase GI symptoms are not as severe in hepatitis A as they are in Hepatitis B Extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase Pruritus is a common problem with jaundice in this phase A patient with acute hepatitis B is being discharged in 2 days. The discharge teaching plan should include instructions to: avoid alcohol for the first 3 weeks use a condom during sex have family members get an injection of immunoglobulin follow a low-protein, moderate-carbohydrate, moderate-fat diet use a condom during sex The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that: shock-wave therapy should be tried initially once gallstones are removed, they tend not to recur the disorder can be successfully treated with oral bile salts that dissolve gallstones laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic Teaching in relation to home management after a laparoscopic cholecystectomy should include: keeping bandages on puncture sites for 48 hours reporting any bile-colored drainage or pus from any incision using OTC antiemetics if nausea and vomiting occur emptying and measuring the contents of the bile bag from the T tube every day reporting any bile-colored drainage or pus from any incision A patient is jaundiced and her stools are colored gray. This most likely relates to: decreased bile flow into intestine increased production of urobilinogen increased bile and bilirubin in the blood increased production of choleystokinin decreased bile flow into intestine A patient is admitted to the hospital with RLQ pain. What organ may be a possible source for this pain? Liver Pancreas Appendix Gallbladder Appendix -liver/gallbladder: RUQ -Pancreas: LUQ Which procedures requires Bowel Prep by laxatives, enemas, or both? (SATA) Barium enema Cholangiogram Colonoscopy Gallbladder ultrasound barium enema colonoscopy Which procedures should you be NPO for? (SATA) Barium enema Cholangiogram Gallbladder ultrasound Esophagogastroduodenoscopy MRI ERCP Barium enema Cholangiogram Gallbladder ultrasound Esophagogastroduodenoscopy ERCP A patient's serum liver enzyme tests reveal an elevated AST. The recognizes what about the elevated AST? It eliminates infection as a cause of liver damage It is diagnostic for liver inflammation and damage Tissue damage in organs other than the liver may be identified Nervous system symptoms related to hepatic encephalopathy may be the cause Tissue damage in organs other than the liver may be identified Checking for the return of the gag reflex and monitoring for LUQ pain, nausea, and vomiting are necessary nursing actions after which diagnostic procedure? ERCP Colonoscopy Defecography Barium swallow ERCP gag reflex is also assessed with an esophagogastroduodenoscopy (EGD) What is the most common cause of chronic disease-related or secondary protein-calorie malnutrition in the US? Unavailability of foods high in protein A lack of knowledge about nutritional needs A lack of money to purchase high-protein foods An alteration in ingestion, digestion, absorption, or metabolism An alteration in ingestion, digestion, absorption, or metabolism In regards to the metabolism of nutrients used for energy during starvation, which one depletes within the first 18 hours? carbohydrates -then skeletal protein, fat, viscera In regards to the metabolism of nutrients used for energy during starvation, which one depletes in 18 hours to 5-9 days? Skeletal protein carbohydrates (18 hr)---skeletal protein---fat---viscera In regards to the metabolism of nutrients used for energy during starvation, which one depletes last? visceral organs carbohydrates (18 hr)---skeletal protein (18 hr to 5-9 days)---fat---viscera What may occur with failure of the sodium-potassium pump during severe protein depletion? ascites anemia hyperkalemia hypoalbuminemia hyperkalemia what contributes to increased protein calorie needs? surgery lowered temperature vegan diet cultural or religious beliefs surgery During assessment of the patient with protein-calorie malnutrition, what should the nurse expect to find? (SATA) Frequent cold symptoms Decreased bowel sounds Cool, rough, dry, scaly skin A flat or concave abdomen Prominent bony structures Decreased reflexes and lack of attention Frequent cold symptoms Decreased bowel sounds Cool, rough, dry, scaly skin Prominent bony structures Decreased reflexes and lack of attention The nurse monitors the lab results of the patient with protein-calorie malnutrition during treatment. Which result is an indication of improvement in the patient's condition? Decreased lymphocytes Increased serum potassium Increased serum transferrin Decreased serum prealbumin increased serum transferrin --in malnutrition, serum transferrin decreases significantly When considering tube feedings for a pt with severe protein-calorie malnutrition, what is an advantage of a G tube versus an NG tube? There is less irritation to the nasal and esophageal mucosa The pt experiences the sights and smells associated with eating Aspiration is less common in G tubes Routine checking is not needed because G tubes stay in place There is less irritation to the nasal and esophageal mucosa Which characteristics of parenteral nutrition apply more to Central Parenteral Nutrition (SATA) Limited to 20% glucose Nutrients can be infused using smaller volumes Long-term nutritional support Increase risk for phlebitis May use PICC line Nutrients can be infused using smaller volumes Long-term nutritional support May use PICC line Which of the following characteristics of parenteral nutrition apply more to Peripheral Parenteral Nutrition? (SATA) Limited to 20% glucose Nutrients can be infused using smaller volumes Supplements inadequate enteral feedings Long-term nutritional support Increased risk for phlebitis Limited to 20% glucose Supplements inadequate enteral feedings Increased risk for phlebitis What is an indication for parenteral nutrition that is not an appropriate indication for enteral tube feedings? Head and neck cancer Hypermetabolic states Malabsorption syndrome Protein-calorie malnutrition Malabsorption syndrome -PN: vein, non-functioning GI When caring for a client following a glossectomy with dissection of the floor of the mouth and a radical neck dissection for cancer of the tongue, what is the nurse's primary concern? Relief of pain Positive body image Patent airway Tube feedings to provide nutrition patent airway ...next concern = tube feedings AIRWAY first then nutrition Duodenal and gastric ulcers have similar as well as differentiating features. What are characteristics unique to duodenal ulcers? (SATA) Pain relieved with eating food High recurrence rate Associated with H. pylori There is burning and cramping in the midepigastric area Pain relieved with eating food Associated with H. pylori There is burning and cramping in the midepigastric area Who has the highest risk for a gastric ulcer? 55 yo female smoker w/ NV 45 yo female admitted for illicit drug detox 27 yo male who is being divorced and has back pain 37 yo male smoker who fell while looking for a job 55 yo female smoker w/ NV Which meds are used to decrease gastric or hydrochloric acid secretion? (SATA) Famotidine Omeprazole Bethanechol Famotidine (H2 blocker) Omeprazole (PPI) (Bethanechol: urinary retention med) A patient with a hx of PUD is hospitalized with symptoms of a perforation. During the initial assessment, what should the nurse expect? Vomiting of bright-red blood Projectile vomiting of undigested food Rigid-board like abdomen Hyperactive bowel sounds and upper abdominal swelling Rigid-board like abdomen (along with shallow respirations and high HR) A patient develops dumping syndrome. The nurses explains that the symptoms associated with this are caused by: distention of the stomach by too much food and fluid intake hyperglycemia caused by uncontrolled gastric emptying irritation of the stomach lining by reflux of bile salts movement of fluid into the small bowel from concentrated food and fluids moving rapidly into the intestine movement of fluid into the small bowel from concentrated food and fluids moving rapidly into the intestine A patient with stomach cancer undergoes a total gastrectomy. Postop, what should the nurse teach the patient to expect? Rapid healing of the surgical wound Lifelong administration of cobalamin To be able to return to normal dietary habits Close follow up for development of peptic ulcers in the jejunum lifelong administration of cobalamin (Vit B) What type of bleeding will a patient with PUD with a slow upper GI source of bleeding have? Melena Occult blood Coffee-ground emesis Profuse bright red hematemesis melena -black tarry stools... A patient with upper GI bleeding and melena is treated with several drugs. Which drug should the nurse recognize as a priority to administer before, during, and potentially after an endoscopy? Oral nizatidine Epinephrine injection Vasopressin injection IV esomeprazole IV esomeprazole -PPI -nizatidine is not as effective as a PPI... PPIs are the strongest at stopping gastric acid secretion Which food has the highest amount of dietary fiber? Peach Popcorn Dried beans Shredded wheat dried beans A patient returns to the surgical unit with a NG tube to low intermittent suction, IV fluids, and JP drain following an exploratory laparotomy and repair of a bowel perforation. Four hours after admission, the pt experiences nausea and vomiting. What is a priority nursing intervention for this patient? assess abdomen for distention and bowel sounds inspect surgical site for drainage in the JP check characteristics of gastric drainage and patency of NG tube administer prescribed ondansetron to control nausea and vomiting check characteristics of gastric drainage and patency of NG tube A patient who just had a major abdominal surgery complains of abdominal pain several afters after the surgery. What action should the nurse take first? Notify HCP Assess VS Position pt w/ knees flexed Determine pt's IV intake since end of surgery assess VS -could be peritonitis A 20 yo patient with a hx of Crohn's disease comes to the clinic with persistent diarrhea. What are common characteristics of Crohn's disease? (SATA) Wt loss Rectal bleeding Abdominal pain Toxic megacolon Skip lesions Involves entire thickness of bowel wall Wt loss Abdominal pain Skip lesions Involves entire thickness of bowel wall For the pt hospitalized with IBD, which treatments would be used to rest the bowel? (SATA) NPO IV fluids Bed rest Sedatives NG suction Parenteral nutrition NPO IV fluids NG suction Parenteral nutrition When obtaining a nursing hx for a client with colorectal cancer, the nurse should specifically ask the patient about: Dietary intake Sports involvement Environmental exposure to carcinogens Long term use of NSAIDs dietary intake (fiber) A nurse examines a patient 8-hours after having a surgery to create a colostomy, the patient's stoma is brick-red, puffy and oozes blood. Is this ok? Yes, it's normal In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient? Semiliquid stools Liquid stools in a pouch Formed stools in a pouch Semiformed stools in a pouch Semiformed stools in a pouch What should the nurse teach the pt with diverticulosis do? Use abx routinely to prevent future inflammation Have an annual colonoscopy to detect malignant changes in the lesions Maintain high-fiber diet and encourage fluid intake of at least 2 L a day Exclude whole grain breads and cereals from the diet to prevent irritating the bowel Maintain high-fiber diet and encourage fluid intake of at least 2 L a day Caring in Nursing Practice caring involves a mutual give and take that develops as nurse an client begin to know and care for one another * have to get to know the client (initial assessment) Providing Presence "being there"- physical and communication "being with"- be available when client needs you Touch contact (skin-to-skin) and non contact (eye) task-oriented touch- explaining procedure caring touch- non-verbal, holding hand, tapping foot protective touch- hold patient to avoid a fall (know which cultures you can touch) Listening not only in taking and what client says- give back understanding Knowing the Client use to make clinical decisions Spiritual Caring spiritual health occurs when a person finds a balance between his or her own life values, goals, and belief systems and those of others Relieving Pain and Suffering more than giving pain medications, repositioning the patient, or cleaning a wound (caring actions, give peace) Family Care helping family members become active participants in clients care * almost more important to know the family, they will be taking care of patient at home Care Persons who do not experience care in their lives often find it difficult to act in caring ways * as a nurse deals with health and illness in their practice, they grow in the ability to care Caring Challenges in the Future * technology * nursing shortage * very ill patients (comorbidities) Caring Behaviors Exhibited by Nurses * empathy * positive attitude (self care) * honesty * advocating patients preferences * make patient comfortable * include family members * smile, touch * its okay not to know the answer C.A.R.E. C- first connect with your client - offer your attention, introduce yourself, ask what they wanna be called, no terms of endearment (sweetie) A- appreciate the clients situation - let them express concern, empathy R- respond to what your client needs - clients priorities and expectations E- empower the client to problem solve with you - client gains strength, confidence with you and care Significant Parts of Patient Centered Care * all day visiting hours * convenient office hours * short wait times * same day appointments * hospitalist: makes decisions for patient Which Characteristic is Unique to the Nurse-Patient Relationship Both are working toward a common goal End of Life-Decision Making - Advance Directives - living will - durable power of attorney for health care - DNR - DNI - IPost