Nokea
A nurse is preparing to administer pantoprazole (Protonix) intravenously. What actions by the nurse are best? (Select all that apply.)
- A. Administer the drug through a separate IV line.
- B. Infuse pantoprazole using an IV pump.
- C. Keep the drug in its original brown bag.
- D. Take vital signs frequently during infusion.
- E. Use an in-line IV filter when infusing.
Correct Answer: A,B,E
Rationale: When infusing pantoprazole, use a separate IV line, a pump, and an in-line filter. A brown wrapper and frequent vital signs are not needed.
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A client with peptic ulcer disease is in the emergency department and reports the pain has gotten much worse over the last several days. The client blood pressure when long days was 122/80 mm Hg and when standing was 98/52 mm Hg. What action by the nurse is most appropriate?
- A. Administer ibuprofen (Motrin).
- B. Call the Rapid Response Team.
- C. Start a large-bore IV with normal saline.
- D. Tell the client to remain lying down.
Correct Answer: C
Rationale: This client has orthostatic changes to the blood pressure, indicating fluid volume loss. The nurse should start a large-bore IV with isotonic solution. Ibuprofen will exacerbate the ulcer. The Rapid Response Team is not needed at this point. The client should be put on safety precautions, which includes staying in bed, but this is not the priority.
An older female client has been prescribed esomeprazole (Nexium) for treatment of chronic gastric ulcers. What teaching is particularly important for this client?
- A. Check with the pharmacist before taking other medications.
- B. Increase intake of calcium and vitamin D.
- C. Report any worsening of symptoms to the provider.
- D. Take the medication for 2 months to be protected.
Correct Answer: B
Rationale: All of this advice is appropriate for any client taking this medication. However, long-term use is associated with osteoporosis and osteoporosis-related fractures. This client is already at higher risk for this problem and should be instructed to increase calcium and vitamin D intake. The other options are appropriate for any client taking any anti-ulcer medication, specific to the use of esomeprazole.
An older client has gastric cancer and is scheduled to have a partial gastrectomy. The family does not want the client to know the diagnosis. What action by the nurse is best?
- A. Ask the family why they feel this way.
- B. Assess family concerns and fears.
- C. Refuse to comply with the family wishes.
- D. Tell the family that such secrets cannot be kept.
Correct Answer: B
Rationale: The nurse should use open-ended questions and statements to fully assess the family's concerns and fears. Asking why questions often puts people on the defensive and is considered a barrier to therapeutic communication. Refusing to comply or stating that secrets cannot be kept may set up an adversarial relationship.
The student nurse learns about risk factors for gastric cancer. Which factors does this include? (Select all that apply.)
- A. Achlorhydria
- B. Chronic atrophic gastritis
- C. Helicobacter pylori infection
- D. Iron deficiency anemia
- E. Pernicious anemia
Correct Answer: A,B,C,E
Rationale: Achlorhydria, chronic atrophic gastritis, H. pylori infection, and pernicious anemia are all risk factors for developing gastric cancer. Iron deficiency anemia is not a risk factor.
The student nurse studying stomach disorders learns that the risk factors for acute gastritis include which of the following? (Select all that apply.)
- A. Alcohol
- B. Caffeine
- C. Corticosteroids
- D. Fruit juices
- E. Nonsteroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: A,B,C,E
Rationale: Risk factors for acute gastritis include alcohol, caffeine, corticosteroids, and chronic NSAID use. Fruit juice is not a risk factor, although in some people it does cause distress.