109 terms

Medical Surgical 260

Medical Surgical 260: Upper and Lower GI problems, Liver, Pancreas, and Biliary tract problems and kidney
STUDY
PLAY
A pt. who is hospitalized with watery, incontinent diarrhea is dx with C-diff. Which action will the nurse include in POC?
Place the pt. in a private room w/contact isolation
A 67 yr-old pt. tells the nurse, "I have problems w/constipation now that I am older, so I use suppository every morning." Which action should the nurse take first?
Assess the pt. about the individual risk factors for constipation.
In teaching a pt. who has chronic constipation about the use of Metamucil, which info will the nurse include?
Lg. amounts of fluids should be taken to prevent impaction or bowel obstruction.
A 23 yr. old woman who is being evaluated for acute lower abdominal pain and vomiting. Which question will be most useful in determining the cause of the pt's symptoms?
"Can you tell me more about your pain?"
A pt. who has blunt abdominal trauma is complaining of severe pain. A peritoneal lavage returns brown drainage with fecal material. Which action will the nurse plan to take next?
Prepare the pt for surgery.
A pt. is admitted to the hospital for eval of right lower quad pain with n/v. Which action should the nurse take?
Apply an ice pack to the right lower quad.
Which nursing action will be included in the plan of care for pt. with bowel irregularity and new dx of IBS?
Encourage the pt to express feelings and ask questions about IBS.
Two days after an exploratory laparotomy with a resection of a short segment of small bowel, a patient complains of gas pains and abdominal distention. Which nursing action is best to take at this time?
Assist the patient to ambulate.
A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to
place the patient on NPO status.
Which nursing action will the nurse include in the plan of care when admitting a patient with an exacerbation of inflammatory bowel disease (IBD)?
Monitor stools for blood.
After the nurse has finished teaching a patient with ulcerative colitis about sulfasalazine (Azulfidine), which patient statement indicates that the teaching has been effective?
"I will need to use a sunscreen when I am outdoors."
A patient who has an exacerbation of ulcerative colitis is having 15 to 20 stools daily and has excoriated perianal skin. Which patient behavior indicates that teaching regarding maintenance of skin integrity has been effective?
The patient uses witch hazel compresses to decrease anal irritation.
After the nurse has provided patient teaching about recommended dietary choices for a patient with an acute exacerbation of inflammatory bowel disease (IBD), which diet choice by the patient indicates a need for more teaching?
Oatmeal with cream
A patient who has had a total proctocolectomy and permanent ileostomy tells the nurse, "I cannot bear to even look at the stoma. I do not think I can manage all these changes." Which is the best action by the nurse?
Ask the patient more about the concerns with stoma management.
When caring for a patient who has a new diagnosis of Crohn's disease after having frequent diarrhea and a weight loss of 10 pounds (4.5 kg) over 2 months, the nurse will plan to teach the patient about
medication use.
A patient with Crohn's disease develops a fever and symptoms of a urinary tract infection (UTI) with tan, fecal-smelling urine. The nurse will teach the patient
about fistula formation between the bowel and bladder.
A patient has a large bowel obstruction that occurred as a result of diverticulosis. When assessing the patient, the nurse will plan to monitor for
abdominal distention.
When preparing for an annual physical exam for a patient who is 50 years old, the nurse will plan to teach the patient about
colonoscopy.
During preoperative preparation for a patient scheduled for an abdominal-perineal resection, the nurse will
administer polyethylene glycol lavage solution (GoLYTELY) to ensure that the bowel is empty before the surgery.
Before undergoing a colon resection for cancer of the colon, a patient has an elevated carcinoembryonic antigen (CEA) test. The nurse explains that the test is used to
monitor the tumor status after surgery.
Which nursing action is most important to include in the plan of care for a patient who had an abdominal-perineal resection the previous day?
Assess the perineal drainage and incision.
During the initial postoperative assessment of a patient's stoma formed from a transverse colostomy, the nurse finds it to be deep pink with moderate edema and a small amount of bleeding. The nurse should
document the stoma assessment.
A patient who has ulcerative colitis has a proctocolectomy and ileostomy. Which information will the nurse include in patient teaching?
Use care when eating high-fiber foods to avoid obstruction of the ileum.
After teaching a patient to irrigate a new colostomy, the nurse will determine that the teaching has been effective if the patient
hangs the irrigating container about 18 inches above the stoma.
The nurse explains to a patient with a new ileostomy that after the bowel adjusts to the ileostomy, the usual drainage will be about
2 cups.
When implementing the initial plan of care for a patient admitted with acute diverticulitis, the nurse will plan to
administer IV fluids.
Which patient education will the nurse provide before discharge for a patient who has had a herniorrhaphy to repair an incarcerated inguinal hernia?
Apply a scrotal support and ice to reduce swelling.
After the nurse has completed teaching a patient with newly diagnosed celiac disease, which breakfast choice by the patient indicates good understanding of the information?
Corn tortilla with eggs
Which instructions will the nurse include in discharge teaching for a patient who has had a hemorrhoidectomy at an outpatient surgical center?
Take prescribed pain medications before a bowel movement is expected.
A patient calls the clinic and tells the nurse about a new onset of severe and frequent, diarrhea. The nurse anticipates that the patient will need to
collect a stool specimen.
A patient with Crohn's disease has megaloblastic anemia. The nurse will anticipate teaching the patient about the ongoing need for
cobalamin (B12) nasal spray or injections
When performing an admission assessment for a patient with abdominal pain, the nurse palpates the left lower quadrant and the patient complains of right lower quadrant pain. The nurse will document this as
Rovsing sign.
A critically ill patient develops incontinence of watery stools. What action will be best for the nurse to take to prevent complications associated with ongoing incontinence?
Implement fecal management system.
When interviewing a patient with abdominal pain and possible irritable bowel syndrome, which question will be most important for the nurse to ask?
"How long have you had abdominal pain?"
Which of these prescribed interventions will the nurse implement first when caring for a patient who has just been diagnosed with peritonitis caused by a ruptured diverticulum?
Infuse metronidazole (Flagyl) 500 mg IV.
A patient with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about all of these symptoms. Which symptom is most important to communicate to the health care provider?
Elevated temperature
After receiving change-of-shift report, which of the following patients should the nurse assess first?
A patient who has abdominal distention and an apical heart rate of 136 beats/minute
A hospitalized patient who has been taking antibiotics for several days develops watery diarrhea. Which action should the nurse take first?
Place the patient on contact precautions.
The nurse who is interviewing a 40-year-old obtains information about the following patient problems. Which information is most important to communicate to the health care provider?
The patient has recently noticed blood in the stools.
A patient is brought to the emergency department with a knife impaled in the abdomen following a domestic fight. During the initial assessment of the patient, the nurse should
assess the BP and pulse.
Following an exploratory laparotomy and bowel resection, a patient who has a nasogastric tube to suction complains of nausea and stomach distention. The first action by the nurse should be to
reposition the tube and check for placement.
A patient with deep partial-thickness burns experiences severe pain associated with nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea?
Administer the prescribed morphine sulfate before dressing changes.
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 dish of lemon gelatin
A patient who is receiving chemotherapy develops a Candida albicans oral infection. The nurse will anticipate the need for
administration of nystatin (Mycostatin) oral tablets.
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?
Red, velvety patches on the buccal mucosa
To decrease the risk for cancers of the tongue and buccal mucosa, which information will the nurse include when teaching a patient who is seen for an annual physical exam in the outpatient clinic?
Avoid use of cigarettes and smokeless tobacco.
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?
"I eat small meals throughout the day and have a bedtime snack."
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 gastroesophageal reflux disease (GERD). The nurse will plan to do frequent assessments of the patient's
breath sounds.
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
treats gastroesophageal reflux disease by decreasing stomach acid production.
After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which diet choice for a snack 2 hours before bedtime indicates that the teaching has been effective?
Cherry gelatin and fruit
A patient who recently has been experiencing frequent heartburn is seen in the clinic. The nurse will anticipate teaching the patient about
proton pump inhibitors.
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?
"Having this new diagnosis must be very hard for you."
Which information will the nurse include when teaching a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
"It will be helpful to keep the head of your bed elevated on blocks."
A patient has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which nursing action should be included in the postoperative plan of care?
Elevate the head of the bed to at least 30 degrees.
The nurse will plan to teach the patient with newly diagnosed achalasia that
endoscopic procedures may be used for treatment.
A patient who is nauseated and vomiting up blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about
use of nonsteroidal anti-inflammatory drugs (NSAIDs).
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,
"The cobalamin injections will prevent me from becoming anemic."
A patient with peptic ulcer disease associated with the presence of Helicobacter pylori is treated with triple drug therapy. The nurse will plan to teach the patient about
amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec).
A patient who has had several episodes of bloody diarrhea is admitted to the emergency department. Which action should the nurse anticipate taking?
Obtain a stool specimen for culture.
A patient is hospitalized with vomiting of "coffee-ground" emesis. The nurse will anticipate preparing the patient for
endoscopy.
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?
Administer loperamide (Imodium) after each stool.
The health care provider orders intravenous (IV) ranitidine (Zantac) for a patient with gastrointestinal (GI) bleeding caused by peptic ulcer disease. When teaching the patient about the effect of the medication, which information will the nurse include?
"Ranitidine decreases secretion of gastric acid."
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
inhibit the development of stress ulcers.
A patient with a bleeding duodenal ulcer has a nasogastric (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
periodically aspirates and tests gastric pH.
A patient with a peptic ulcer who has a nasogastric (NG) tube develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which action should the nurse take next?
Obtain the vital signs.
Twelve hours after undergoing a gastroduodenostomy (Billroth I), a patient complains of increasing abdominal pain. The patient has absent bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The most appropriate action by the nurse at this time is to
notify the surgeon.
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?
"Vitamin supplements may be needed to prevent problems with anemia."
A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. To avoid recurrence of these symptoms, the nurse teaches the patient to
lie down for about 30 minutes after eating.
A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about
the benefits of misoprostol (Cytotec) in protecting the gastrointestinal (GI) mucosa.
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
antacids after eating and sucralfate 30 minutes before eating.
Which information will be best for the nurse to include when teaching a patient with peptic ulcer disease (PUD) about dietary management of the disease?
"Avoid foods that cause pain after you eat them."
A patient with a recent 20-pound unintended weight loss is diagnosed with stomach cancer. Which nursing action will be included in the plan of care?
Offer supplemental feedings between meals.
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
smoked foods such as bacon and ham.
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?
The patient is lethargic and difficult to arouse.
The health care provider prescribes the following therapies for a patient who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order will the nurse implement first?
Infuse normal saline at 250 mL/hr.
After receiving change-of-shift report, which patient should the nurse assess first?
A patient with esophageal varices who has a blood pressure of 96/54 mm Hg
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?
The patient has absent breath sounds throughout the left lung.
All of the following orders are received for a patient who has vomited 1500 mL of bright red blood. Which order will the nurse implement first?
Infuse 1000 mL of lactated Ringer's solution.
A patient with acute gastrointestinal (GI) bleeding is receiving normal saline IV at a rate of 500 mL/hr. Which assessment finding obtained by the nurse is most important to communicate immediately to the health care provider?
The patient's lungs have crackles audible to the midline.
A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal
anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).
The nurse determines that administration of hepatitis B vaccine to a patient has been effective when a specimen of the patient's blood reveals
anti-HBs.
A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate?
Schedule the patient for HCV genotype testing.
When a patient is diagnosed with acute hepatitis B, the nurse will plan to teach the patient about
measures that will be helpful in improving appetite.
When combination therapy of -interferon and ribavirin (Rebetol) is being used to treat chronic hepatitis C, the nurse will plan to monitor for
leukopenia.
A patient is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate?
"Do you use any over-the-counter (OTC) drugs?"
A patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) has a serum potassium level of 3.2 mEq/L (3.2 mmol/L). Which action should the nurse take?
Administer the spironolactone.
A patient who has advanced cirrhosis is receiving lactulose (Cephulac). Which finding by the nurse indicates that the medication is effective?
The patient is alert and oriented.
The health care provider plans a paracentesis for a patient with ascites caused by liver cancer. To prepare the patient for the procedure, the nurse
asks the patient to empty the bladder.
When assessing a patient who had a liver transplant a week previously, the nurse obtains the following data. Which finding is most important to communicate to the health care provider?
Temperature 100.8° F (38.2° C)
Which of these laboratory test results will be most important for the nurse to monitor when evaluating the effects of therapy for a patient who has acute pancreatitis?
Amylase
Which assessment finding in a patient with acute pancreatitis would the nurse need to report most quickly to the health care provider?
Muscle twitching and finger numbness
Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern?
The patient's hands flap back and forth when the arms are extended.
A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which assessment finding is the best indicator that the medication has been effective?
Stools test negative for occult blood.
A patient is admitted to the hospital with acute cholecystitis. Which assessment information will be most important for the nurse to report to the health care provider?
The patient's stools are clay colored.
After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take?
Report the patient's symptoms to the health care provider.
A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for
rapid respirations.
A patient with severe heart failure develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet the goal of
maintaining cardiac output.
A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV?
Cardiac rhythm
A patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which of these orders for the patient will the nurse question?
Ibuprofen (Advil) 400 mg PO PRN for pain
Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)?
Phosphate level
The nurse has instructed a patient who is receiving hemodialysis about appropriate dietary choices. Which menu choice by the patient indicates that the teaching has been successful?
Scrambled eggs, English muffin, and apple juice
Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?
Calculated glomerular filtration rate (GFR)
A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it
is much less likely to clot.
The nurse is caring for a patient who had kidney transplantation several years ago. Which assessment finding may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid?
Joint pain
A patient with hypertension and stage 2 chronic kidney disease (CKD) is receiving captopril (Capoten). Before administration of the medication, the nurse will check the patient's
potassium.
A new order for IV gentamicin (Garamycin) 60 mg BID is received for a patient with diabetes who has pneumonia. When evaluating for adverse effects of the medication, the nurse will plan to monitor the patient's
blood urea nitrogen (BUN) and creatinine.
Which information about a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration will be most important for the nurse to report to the health care provider?
Urine output over an 8-hour period is 2500 mL.
The RN observes an LPN/LVN carrying out all of the following actions while caring for a patient with stage 2 chronic kidney disease. Which action requires the RN to intervene?
The LPN/LVN gives the iron supplement and phosphate binder with lunch.
Two hours after a kidney transplant, the nurse obtains all of the following data when assessing the patient. Which information is most important to communicate to the health care provider?
The patient's central venous pressure (CVP) is decreased.
YOU MIGHT ALSO LIKE...