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1. Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?
a. The patient has been vomiting several times a day for the last 4 days.
b. The patient is lethargic and difficult to arouse.
c. The patient's chart indicates a recent resection of the small intestine.
d. The patient has taken only sips of water.

Answer: B
Rationale: 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.

Cognitive Level: Application Text Reference: p. 991
Nursing Process: Assessment NCLEX: Physiological Integrity

2. A patient with deep partial-thickness (second-degree) burns over 70% of the body experiences severe pain associated with nausea and occasional vomiting during dressing changes. To promote relief of the patient's nausea and vomiting, the nurse should
a. administer the prescribed morphine sulfate before dressing changes.
b. avoid performing dressing changes close to the patient's mealtimes.
c. keep the patient NPO for 2 hours before and after dressing changes.
d. give the ordered prochlorperazine (Compazine) before dressing changes.

Answer: A
Rationale: Because the patient's nausea and vomiting are associated with severe pain, it is likely that they are precipitated by stress and pain. The best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea/vomiting that occur at other times should also be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient's nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain.

Cognitive Level: Application Text Reference: p. 991
Nursing Process: Implementation NCLEX: Physiological Integrity

3. Which of these nursing actions should the RN working in the emergency department delegate to a nursing assistant who is helping with the care of a patient who has been admitted with nausea and vomiting?
a. Assess for signs of dehydration.
b. Ask the patient what precipitated the nausea.
c. Auscultate the bowel sounds.
d. Assist the patient with oral care after vomiting.

Answer: D
Rationale: Oral care is included in nursing assistant education and scope of practice. The other actions are all assessments that require more education and a higher scope of nursing practice.

Cognitive Level: Application Text Reference: pp. 992-995
Nursing Process: Implementation NCLEX: Physiological Integrity

4. A patient who has been NPO during treatment for nausea and vomiting caused by gastric irritation is to start oral intake. Which of these should the nurse offer to the patient?
a. A glass of orange juice
b. A bowl of hot chicken broth
c. A dish of lemon gelatin
d. A cup of coffee with cream

Answer: C
Rationale: Clear liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.

Cognitive Level: Comprehension Text Reference: pp. 992, 995
Nursing Process: Implementation NCLEX: Physiological Integrity

5. All the following orders are received for a patient who has been admitted with dehydration after 3 days of nausea and vomiting. Which order will the nurse act on first?
a. Provide oral care with moistened swabs.
b. Infuse normal saline at 250 ml/hr.
c. Insert a 16-gauge nasogastric (NG) tube.
d. Administer IV ondansetron (Zofran).

Answer: B
Rationale: Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished as quickly as possible after the IV fluids are initiated.

Cognitive Level: Application Text Reference: pp. 993-994
Nursing Process: Implementation NCLEX: Physiological Integrity

6. A patient who is receiving chemotherapy develops a Candida albicans oral infection. The nurse will anticipate the need for
a. hydrogen peroxide rinses.
b. administration of nystatin (Mycostatin) oral tablets.
c. the use of antiviral agents.
d. referral to a dentist for professional tooth cleaning.

Answer: B
Rationale: Candida albicans is treated with an antifungal such as nystatin. Oral saltwater rinses may be used but will not cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is indicated for gingivitis but not for Candida infection.

Cognitive Level: Application Text Reference: p. 1000
Nursing Process: Planning NCLEX: Physiological Integrity

7. When the nurse is assessing the mouth of a patient who uses smokeless tobacco for signs of oral cancer, which finding will be of most concern?
a. A 3-mm ulcer on the floor of the mouth
b. A red, velvety patch on the buccal mucosa
c. White, curdlike plaques on the back of the tongue
d. Painful blisters at the border of the lips

Answer: B
Rationale: A red, velvety patch suggests erythroplasia, which has a high incidence (greater than 50%) of progression to squamous cell carcinoma. The other lesions are suggestive of acute processes (aphthous stomatitis, oral candidiasis, and herpes simplex).

Cognitive Level: Comprehension Text Reference: p. 1001
Nursing Process: Assessment NCLEX: Physiological Integrity

8. The nurse is admitting a patient who has been diagnosed with squamous cell carcinoma of the buccal mucosa. When interviewing the patient for the health history, the nurse will ask about
a. any use of tobacco by the patient.
b. any history of streptococcal throat infection.
c. chronic overexposure to the sun.
d. recurrent herpes simplex (HSV) infections.

Answer: A
Rationale: Tobacco use greatly increases the risk for oral cancer. History of acute infections such as strep throat is not a risk factor for oral cancer, although chronic irritation of the oral mucosa does increase risk. Sun exposure does not increase the risk for cancers of the buccal mucosa. Human papillomavirus infection (HPV) infection may be associated with increased risk, but HSV infection is not a risk factor for oral cancer.

Cognitive Level: Comprehension Text Reference: pp. 1001-1002
Nursing Process: Assessment NCLEX: Physiological Integrity

9. A patient with oral squamous cell carcinoma is transferred to the postoperative surgical unit after a hemiglossectomy and radical neck procedure. When planning care the nurse will anticipate the need to
a. insert a long-term central venous catheter for parenteral nutrition.
b. use an alphabet board to assist the patient with communication.
c. administer chemotherapy starting the first postoperative day.
d. reinforce pressure dressings at the surgical incision.

Answer: B
Rationale: The patient will have a tracheostomy after having a radical neck procedure, and the nurse should plan ways to allow the patient to communicate. IV fluids (but not parenteral nutrition) are given for 24 to 48 hours, followed by enteral feedings. Chemotherapy is not started until after surgical wounds have healed. Pressure dressings are not used because they could obstruct the patient's airway.

Cognitive Level: Application Text Reference: p. 1003
Nursing Process: Planning NCLEX: Physiological Integrity

10. The nurse is assessing a patient with gastroesophageal reflux disease (GERD) who is experiencing increasing discomfort. Which patient statement indicates that additional patient education about GERD is needed?
a. "I take antacids between meals and at bedtime each night."
b. "I quit smoking several years ago, but I still chew a lot of gum."
c. "I sleep with the head of the bed elevated on 4-inch blocks."
d. "I eat small meals throughout the day and have a bedtime snack."

Answer: D
Rationale: GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.

Cognitive Level: Application Text Reference: p. 1005
Nursing Process: Evaluation NCLEX: Physiological Integrity

11. When admitting a patient with a stroke who is unconscious and unresponsive to stimuli, the nurse learns from the patient's family that the patient has a history of GERD. The nurse will plan to do frequent assessment of the patient's
a. bowel sounds.
b. breath sounds.
c. apical pulse.
d. abdominal girth.

Answer: B
Rationale: Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient's stroke or GERD and do not require more frequent monitoring than the routine.

Cognitive Level: Application Text Reference: p. 1005
Nursing Process: Assessment NCLEX: Physiological Integrity

12. A patient with recurring heartburn receives a new prescription for esomeprazole (Nexium). In teaching the patient about this medication, the nurse explains that this drug
a. reduces the reflux of gastric acid by increasing the rate of gastric emptying.
b. coats and protects the lining of the stomach and esophagus from gastric acid.
c. treats gastroesophageal reflux disease by decreasing stomach acid production.
d. neutralizes stomach acid and provides relief of symptoms in a few minutes.

Answer: C
Rationale: The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.

Cognitive Level: Comprehension Text Reference: pp. 998, 1006
Nursing Process: Implementation NCLEX: Physiological Integrity

13. After the nurse teaches a patient with GERD about recommended dietary modifications, which diet choice for a snack 2 hours before bedtime indicates that the teaching has been effective?
a. Chocolate pudding
b. Glass of low-fat milk
c. Peanut butter sandwich
d. Cherry gelatin and fruit

Answer: D
Rationale: Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods like chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.

Cognitive Level: Application Text Reference: p. 1005
Nursing Process: Evaluation NCLEX: Physiological Integrity

14. Which of these assessment findings in a patient with a hiatal hernia who returned from a laparoscopic Nissen fundoplication 4 hours ago is most important for the nurse to address immediately?
a. The patient has absent breath sounds throughout the left lung.
b. The patient complains of 6/10 (of a 0-10 scale) abdominal pain.
c. The patient has decreased bowel sounds in all four quadrants.
d. The patient is experiencing intermittent waves of nausea.

Answer: A
Rationale: Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The abdominal pain and nausea should also be addressed but are not as high priority as the patient's respiratory status. The patient's decreased bowel sounds are expected after surgery and require ongoing monitoring but no other action.

Cognitive Level: Application Text Reference: p. 1008
Nursing Process: Assessment NCLEX: Physiological Integrity

15. A patient who has recently been experiencing frequent heartburn is seen in the clinic. The nurse will anticipate teaching the patient about
a. endoscopy procedures.
b. barium swallow.
c. radionuclide tests.
d. proton pump inhibitors.

Answer: D
Rationale: Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.

Cognitive Level: Application Text Reference: p. 1005
Nursing Process: Planning NCLEX: Physiological Integrity

16. A 62-year-old patient who has been diagnosed with esophageal cancer tells the nurse, "I know that my chances are not very good, but I do not feel ready to die yet." Which response by the nurse is most appropriate?
a. "You may have quite a few years to live still left."
b. "Having this new diagnosis must be very hard for you."
c. "Thinking about dying will only make you feel worse."
d. "It is important that you be realistic about your prognosis."

Answer: B
Rationale: This response is open-ended and will encourage the patient to further discuss feelings of anxiety or sadness about the diagnosis. Patients with esophageal cancer have only a 20% 5-year survival rate, so the response "You may have quite a few years to live still yet" is misleading. The response beginning, "Thinking about dying" indicates that the nurse is not open to discussing the patient's fears of dying. And the response beginning, "It is important that you be realistic," discourages the patient from feeling hopeful, which is important to patients with any life-threatening diagnosis.

Cognitive Level: Application Text Reference: p. 1011
Nursing Process: Implementation NCLEX: Psychosocial Integrity

17. Which information will the nurse include when teaching a patient with newly diagnosed GERD?
a. "Peppermint tea may be helpful in reducing your symptoms."
b. "You will need to keep the head of your bed elevated on blocks."
c. "You should avoid eating between meals to reduce acid secretion."
d. "Vigorous physical activities may increase the incidence of reflux."

Answer: B
Rationale: Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will lower LES pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distension. There is no need to make changes in physical activities because of GERD.

Cognitive Level: Application Text Reference: p. 1007
Nursing Process: Implementation NCLEX: Physiological Integrity

18. A patient has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which nursing actions should be included in the postoperative plan of care?
a. Elevate the head of the bed to at least 30 degrees.
b. Reposition NG tube if drainage stops or decreases.
c. Notify doctor immediately about bloody NG drainage.
d. Start oral fluids when patient has active bowel sounds.

Answer: A
Rationale: Elevation of the head of the bed decreases the risk for reflux and aspiration of gastric secretions. The NG tube should not be repositioned without consulting with the health care provider. Bloody NG drainage is expected for the first 8 to 12 hours. A swallowing study is needed before oral fluids are started.

Cognitive Level: Application Text Reference: p. 1011
Nursing Process: Planning NCLEX: Physiological Integrity

19. The nurse will plan to teach the patient with newly diagnosed achalasia that
a. drinking fluids with meals should be avoided.
b. lying down and resting after meals is recommended.
c. a liquid or blenderized diet will be necessary.
d. endoscopic procedures may be used for treatment.

Answer: D
Rationale: Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Patients are advised to drink fluid with meals. Keeping the head elevated after eating will improve esophageal emptying. A semisoft diet is recommended to improve esophageal emptying.

Cognitive Level: Application Text Reference: p. 1012
Nursing Process: Planning NCLEX: Physiological Integrity

20. A patient who is nauseated and vomiting up blood streaked fluid is admitted to the hospital with acute gastritis. When obtaining the admission health history, it will be most important for the nurse to ask the patient about
a. frequency of nonsteroidal antiinflammatory drug (NSAID) use.
b. family history of gastric problems.
c. recent weight gain or loss.
d. the amount of fat in the diet.

Answer: A
Rationale: 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.

Cognitive Level: Application Text Reference: p. 1013
Nursing Process: Assessment NCLEX: Physiological Integrity

21. Cobalamin injections have been prescribed for a patient with chronic atrophic gastritis. The nurse determines that teaching regarding the injections has been effective when the patient states,
a. "These injections will decrease my risk for developing stomach cancer."
b. "These injections will increase the hydrochloric acid in my stomach."
c. "The cobalamin injections need to be taken until my inflamed stomach heals."
d. "The cobalamin injections will prevent me from becoming anemic."

Answer: D
Rationale: Cobalamin supplementation prevents the development of pernicious anemia. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin.

Cognitive Level: Application Text Reference: p. 1014
Nursing Process: Evaluation NCLEX: Physiological Integrity

22. A patient with chronic gastritis associated with the presence of Helicobacter pylori is treated with triple-drug therapy. The nurse explains to the patient that the drugs commonly included in this regimen include
a. famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole (Protonix).
b. amoxicillin (Amoxil ), clarithromycin (Biaxin), and omeprazole (Prilosec).
c. sucralfate (Carafate), nystatin (Mycostatin), and bismuth subsalicylate (Pepto-Bismol).
d. metoclopramide (Reglan), bethanechol (Urecholine), and promethazine (Phenergan).

Answer: B
Rationale: 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.

Cognitive Level: Comprehension Text Reference: p. 1014
Nursing Process: Implementation NCLEX: Physiological Integrity

23. The health care provider orders insertion of a 20-gauge orogastric tube for a patient experiencing massive hematemesis. As the nurse inserts the tube, resistance is met in advancing the tube. The appropriate action by the nurse is to
a. ask the patient to hyperextend the neck.
b. stop and notify the health care provider of the resistance.
c. inject additional lubricant through the tube.
d. withdraw the tube a few inches and then reinsert.

Answer: B
Rationale: No tube should be advanced against resistance because of the risk for mucosal damage or perforation of the esophagus. Hyperextension of the neck will increase the likelihood of insertion into the trachea. Because the tube may be in the trachea, injection of lubricant may cause aspiration. Withdrawal and reinsertion of the tube will increase the risk for mucosal damage or perforation.

Cognitive Level: Application Text Reference: p. 996
Nursing Process: Implementation NCLEX: Physiological Integrity

24. A patient is hospitalized with vomiting of "coffee-ground" emesis. The nurse will anticipate preparing the patient for
a. endoscopy.
b. angiography.
c. gastric analysis testing.
d. barium contrast studies.

Answer: A
Rationale: Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy can not be done, because it is more invasive and has more possible complications. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding.

Cognitive Level: Application Text Reference: p. 997
Nursing Process: Planning NCLEX: Physiological Integrity

25. A patient who is vomiting bright red blood is admitted to the emergency department. Which assessment should the nurse accomplish first?
a. Measuring the quantity of any emesis
b. Checking the level of consciousness
c. Auscultating the chest for breath sounds
d. Taking the blood pressure (BP) and pulse

Answer: D
Rationale: The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute GI bleeding; BP and pulse are the best indicators of these complications. The other information is also important to obtain, but BP and pulse rate are the best indicators for hypoperfusion.

Cognitive Level: Application Text Reference: p. 997
Nursing Process: Assessment NCLEX: Physiological Integrity

26. The health care provider orders IV vasopressin (Pitressin) to be administered to a patient with esophageal bleeding. During administration of the drug, the nurse will monitor the patient for
a. polyuria.
b. metabolic alkalosis.
c. intention tremors.
d. chest pain.

Answer: D
Rationale: Vasopressin decreases coronary artery perfusion and may cause coronary ischemia. The other symptoms are not adverse effects associated with vasopressin.

Cognitive Level: Application Text Reference: p. 997
Nursing Process: Evaluation NCLEX: Physiological Integrity

27. The health care provider orders IV ranitidine (Zantac) for a patient with an acute exacerbation of chronic peptic ulcer disease. When teaching the patient about the effect of the medication, which information will the nurse include?
a. "Ranitidine constricts the blood vessels in the stomach and decreases bleeding."
b. "Ranitidine decreases secretion of gastric acid."
c. "Ranitidine neutralizes the acid in the stomach."
d. "Ranitidine covers the ulcer with a protective material which promotes healing."

Answer: B
Rationale: Ranitidine is a histamine-2 (H2) receptor blocker, which decreases the secretion of gastric acid. The response beginning, "Ranitidine constricts the blood vessels" describes the effect of vasopressin. The response beginning "Ranitidine neutralizes the acid" describes the effect of antacids. And the response beginning "Ranitidine covers the ulcer" describes the action of sucralfate (Carafate).

Cognitive Level: Application Text Reference: pp. 998, 1019
Nursing Process: Implementation NCLEX: Physiological Integrity

28. The family member of a patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will
a. decrease the risk for nausea and vomiting.
b. prevent aspiration of gastric contents.
c. inhibit the development of stress ulcers.
d. lower the chance for H. pylori infection.

Answer: C
Rationale: 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.

Cognitive Level: Application Text Reference: pp. 996, 998, 1017, 1019
Nursing Process: Implementation NCLEX: Physiological Integrity

29. A patient with a bleeding duodenal ulcer has an NG tube in place, and the health care provider orders 30 ml of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse
a. periodically aspirates and tests gastric pH.
b. measures the amount of residual stomach contents hourly.
c. monitors arterial blood gas values on a daily basis.
d. checks each stool for the presence of occult blood.

Answer: A
Rationale: The purpose for antacids is to increase gastric pH; checking gastric pH is the most direct way of evaluating the effectiveness of the medication. Arterial blood gases may change slightly, but this does not directly reflect the effect of antacids on gastric pH. Because the patient has upper GI bleeding, occult blood in the stools will appear even after the acute bleeding has stopped. The amount of residual stomach contents is not a reflection of resolution of bleeding or of gastric pH.

Cognitive Level: Application Text Reference: p. 1020
Nursing Process: Evaluation NCLEX: Physiological Integrity

30. A patient with a peptic ulcer who has an NG tube develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which action should the nurse take next?
a. Irrigate the NG tube.
b. Obtain the vital signs.
c. Give the ordered antacid.
d. Listen for bowel sounds.

Answer: B
Rationale: 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. The nurse should assess the bowel sounds, but this is not the first action that the nurse should take.

Cognitive Level: Application Text Reference: pp. 1023-1024
Nursing Process: Implementation NCLEX: Physiological Integrity

31. Twelve hours after undergoing a gastroduodenostomy (Billroth I) for treatment of a perforated ulcer, a patient complains of increasing abdominal pain. The nursing assessment reveals an absence of bowel sounds and 200 ml of bright red NG drainage in the last hour. The most appropriate action by the nurse at this time is to
a. notify the health care provider.
b. irrigate the NG tube.
c. administer the ordered morphine sulfate.
d. continue to monitor the NG drainage.

Answer: A
Rationale: 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 and/or return to surgery are needed. Because the NG is draining, there is no indication that irrigation is needed. The patient may need morphine, but this is not the highest priority action. Continuing to monitor the NG drainage is not an adequate response.

Cognitive Level: Application Text Reference: p. 1027
Nursing Process: Implementation NCLEX: Physiological Integrity

32. The nurse implements discharge teaching for a patient following a gastroduodenostomy for treatment of a peptic ulcer. Which patient statement indicates that the teaching has been effective?
a. "I will need to choose foods that are low in fat and high in carbohydrate."
b. "I will try to drink liquids along with my meals."
c. "Vitamin injections may be needed to prevent problems with anemia."
d. "The surgery has cured my peptic ulcer disease."

Answer: C
Rationale: Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin injections. Foods that have moderate fat and low carbohydrate should be chosen to prevent dumping syndrome. Ingestion of liquids with meals is avoided to prevent dumping syndrome. Peptic ulcer disease (PUD) is a chronic problem, and the patient will need to continue lifestyle changes and perhaps medications to prevent recurrence.

Cognitive Level: Application Text Reference: p. 1027
Nursing Process: Evaluation NCLEX: Physiological Integrity

33. A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations, with an urge to defecate about 20 minutes after eating. To avoid recurrence of these symptoms, the nurse teaches the patient to
a. increase the amount of fluid intake with meals.
b. lie down for about 30 minutes after eating.
c. drink sugared fluids or eat candy after each meal.
d. choose foods that are high in carbohydrates.

Answer: B
Rationale: The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down 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.

Cognitive Level: Application Text Reference: p. 1027
Nursing Process: Implementation NCLEX: Physiological Integrity

34. All of these orders are received for a patient who has vomited 1500 ml of bright red blood. Which order will the nurse act on first?
a. Infuse 1000 ml of lactated Ringer's solution.
b. Administer IV famotidine (Pepcid) 40 mg.
c. Insert NG tube and connect to suction.
d. Type and cross match for 4 units of packed red blood cells.

Answer: A
Rationale: Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions are also important to implement quickly but are not the highest priorities.

Cognitive Level: Application Text Reference: p. 996
Nursing Process: Implementation NCLEX: Physiological Integrity

35. A patient who requires daily use of a nonsteroidal antiinflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about
a. the use of ranitidine (Zantac) to decrease the risk for peptic ulcers.
b. reasons for using corticosteroids to treat the arthritis.
c. substitution of acetaminophen (Tylenol) for the NSAID.
d. the benefits of misoprostol (Cytotec) in protecting the GI mucosa.

Answer: D
Rationale: Misoprostol, a prostaglandin analog, is the only drug approved in the United States for preventing gastric ulcers induced by NSAIDs. Ranitidine does increase pH but is not approved for prevention of ulcers in patients chronically taking NSAIDs. Corticosteroids increase risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating the patient's rheumatoid arthritis.

Cognitive Level: Application Text Reference: p. 1021
Nursing Process: Planning NCLEX: Physiological Integrity

36. The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take
a. sucralfate and antacids together 30 minutes before each meal.
b. antacids 30 minutes before the sucralfate.
c. sucralfate at bedtime and antacids before meals.
d. antacids after eating and sucralfate 30 minutes before eating.

Answer: D
Rationale: Sucralfate is most effective when the pH is low and should not be given with or soon after antacid. 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.

Cognitive Level: Comprehension Text Reference: pp. 1020-1021
Nursing Process: Implementation NCLEX: Physiological Integrity

37. Which information will be best for the nurse to include when teaching a patient with PUD about dietary management of the disease?
a. "You should avoid eating many raw fruits and vegetables."
b. "High-protein foods are least likely to cause pain."
c. "Avoid foods that cause pain after you eat them."
d. "You will need to remain on a bland diet indefinitely."

Answer: C
Rationale: The best information is that each individual 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 and some patients may tolerate these well. High-protein foods help to 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 scientific evidence to support their use.

Cognitive Level: Application Text Reference: p. 1021
Nursing Process: Implementation NCLEX: Physiological Integrity

38. A patient with acute GI bleeding is receiving normal saline IV at a rate of 500 ml/hr. Which assessment data obtained by the nurse are most important to communicate immediately to the health care provider?
a. The NG suction is returning coffee-ground material.
b. The patient's lungs have crackles audible to the midline.
c. The patient's BP has increased to 142/94 mm Hg.
d. The bowel sounds are very hyperactive in all four quadrants.

Answer: B
Rationale: The patient's lung sounds indicate that pulmonary edema may be developing as a result of the rapid infusion of IV fluid and that the fluid infusion rate should 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.

Cognitive Level: Application Text Reference: p. 999
Nursing Process: Assessment NCLEX: Physiological Integrity

39. A patient who has intermittent epigastric distress, weight loss, and ascites is diagnosed with stomach cancer. The nurse plans care for the patient with the knowledge that these findings indicate that
a. the patient has a poor prognosis with any therapy.
b. surgical intervention is not indicated for the patient.
c. radiation therapy is the treatment of choice for the patient.
d. the patient will need a referral to hospice services.

Answer: A
Rationale: Survival rate for patients with stomach cancer is low and the presence of ascites indicates metastasis and is a poor prognostic sign. The patient may be a candidate for surgery, which is the only curative treatment for stomach cancer. Radiation may be used, but it is not the treatment of choice because stomach cancers do not respond well to radiation. The patient may need a referral to hospice services, but this will depend on factors such as the patient's desires and how long the patient is projected to live.

Cognitive Level: Application Text Reference: p. 1028
Nursing Process: Planning NCLEX: Physiological Integrity

40. When counseling a patient with a family history of stomach cancer about ways to decrease risk for developing stomach cancer, the nurse will teach the patient to avoid
a. chronic use of H2-blocking medications.
b. emotionally or physically stressful situations.
c. smoked foods such as bacon and ham.
d. foods that cause abdominal distension.

Answer: C
Rationale: Smoked foods such as bacon, ham, and smoked sausage increase the risk for stomach cancer. Use of H2 blockers, stressful situations, and abdominal distension are not associated with an increased incidence of stomach cancer.

Cognitive Level: Application Text Reference: p. 1028
Nursing Process: Implementation NCLEX: Physiological Integrity

41. The nurse will instruct the patient with GERD who is being discharged after a Stretta procedure that
a. acetaminophen (Tylenol) tablets can be used for pain.
b. postoperative nausea is an expected symptom.
c. gelatin, clear broth, and tea are appropriate foods for the next 24 hours.
d. intake and output should be measured and reported to the health care provider.

Answer: C
Rationale: The patient should remain on clear liquids for the first 24 hours after the Stretta procedure. Liquid medications, rather than tablets, are used to decrease irritation at the site. The patient is instructed to notify the health care provider if nausea or vomiting occurs. There is no need for the patient to monitor intake and output.

Cognitive Level: Application Text Reference: p. 1007
Nursing Process: Implementation NCLEX: Physiological Integrity

42. Which nursing diagnosis is appropriate for the home health nurse to use when planning care for a patient who has had a total gastrectomy with an anastomosis of the esophagus to the jejunum for treatment of stomach cancer?
a. Chronic pain related to altered GI tract function secondary to the surgery
b. Risk for infection related to ongoing need for parenteral nutrition
c. Risk for impaired skin integrity related to leakage from jejunostomy tube
d. Imbalanced nutrition: less than body requirements related to inability to absorb nutrients

Answer: D
Rationale: After this procedure, there will be less surface area for nutrient absorption and vitamins that are normally absorbed in the duodenum will have poor absorption. Chronic pain may occur, but this is due to cancer, not to changes that occur in GI function because of surgery. Parenteral nutrition may be used in the immediate postoperative period but is not needed on an ongoing basis. The patient will not have a jejunostomy tube.

Cognitive Level: Application Text Reference: p. 1031
Nursing Process: Diagnosis NCLEX: Physiological Integrity

43. The nurse suspects the possibility of Escherichia coli O157:H7 food poisoning when several individuals who have eaten in the same restaurant develop
a. fever and chills.
b. hemorrhagic diarrhea.
c. muscular incoordination.
d. nausea and vomiting.

Answer: B
Rationale: E. coli O157:H7 causes hemorrhagic colitis with bloody diarrhea. Fever and chills are not typical clinical manifestations of food poisoning. Muscular incoordination is seen with botulism. Nausea and vomiting are common with some forms of food poisoning, but not with E. coli O157:H7.

Cognitive Level: Comprehension Text Reference: p. 1031
Nursing Process: Assessment NCLEX: Physiological Integrity

44. A 22-year-old patient with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. All of the following orders are received. Which order will the nurse question?
a. Infuse lactated Ringer's solution at 250 ml/hr.
b. Monitor blood urea nitrogen and creatinine daily.
c. Administer loperamide (Imodium) after each stool.
d. Provide a clear liquid diet and progress diet as tolerated.

Answer: C
Rationale: Use of antidiarrheal agents is avoided with this type of food poisoning. The other orders are appropriate.

Cognitive Level: Application Text Reference: pp. 1031, 1033
Nursing Process: Implementation NCLEX: Physiological Integrity

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