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A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. Which of the following information should the nurse include in the teaching plan?
- A. Substitution of acetaminophen for the NSAID
- B. Use of enteric-coated NSAIDs to reduce gastric irritation
- C. Reasons for using corticosteroids to treat the rheumatoid arthritis
- D. The benefits of misoprostol in protecting the gastrointestinal (GI) mucosa
Correct Answer: D
Rationale: Misoprostol, a prostaglandin analogue, reduces acid secretion and incidence of upper GI bleeding associated with NSAID use. Enteric coating of NSAIDs does not reduce the risk for GI bleeding. Corticosteroids increase the risk for ulcer development and will not be substituted for NSAIDs for this patient. Acetaminophen will not be effective in treating the patient's rheumatoid arthritis.
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The nurse is admitting a patient who is vomiting bright red blood to the emergency department. Which of the following assessments should the nurse perform first?
- A. Checking the level of consciousness
- B. Measuring the quantity of any emesis
- C. Auscultating the chest for breath sounds
- D. Taking the blood pressure (BP) and pulse
Correct Answer: D
Rationale: The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal (GI) bleeding. BP and pulse are the best indicators of these complications. The other information also is important to obtain, but BP and pulse rate are the best indicators for hypoperfusion.
The nurse is providing discharge teaching for a patient following a gastroduodenostomy for treatment of a peptic ulcer. Which of the following patient statements indicate that the teaching has been effective?
- A. Persistent heartburn is expected after surgery.
- B. I will try to drink liquids along with my meals.
- C. Vitamin supplements may be needed to prevent problems with anemia.
- D. I will need to choose foods that are low in fat and high in carbohydrate.
Correct Answer: C
Rationale: Cobalamin deficiency may occur after partial gastrectomy, and the patient may need to receive cobalamin via injections or nasal spray. 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. Although peptic ulcer disease may recur, persistent heartburn is not expected after surgery and the patient should call the health care provider if this occurs.
The nurse is admitting a patient with Escherichia coli O157:H7 food poisoning who has bloody diarrhea and dehydration. Which of the following prescriptions should the nurse question?
- A. Infuse lactated Ringer's solution at 250 ml/hour
- B. Monitor blood urea nitrogen and creatinine daily.
- C. High protein, high fat diet.
- D. Provide a clear liquid diet and progress diet as tolerated.
Correct Answer: C
Rationale: The patient would not have an intake of solid food at this time. Clear fluids would be ordered. The other orders are appropriate.
The nurse is caring for a patient with a bleeding duodenal ulcer who has a nasogastric (NG) tube in place and a prescription for 30 mL of aluminum hydroxide/magnesium hydroxide to be instilled through the tube every hour. Which of the following assessments should the nurse do to evaluate the effectiveness of this treatment?
- A. Periodically aspirate and test gastric pH.
- B. Monitor arterial blood gas values on a daily basis.
- C. Check each stool for the presence of occult blood.
- D. Measure the amount of residual stomach contents hourly.
Correct 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 gastrointestinal (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.
Which of the following presentations 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 is experiencing intermittent waves of nausea
- B. The patient has absent breath sounds throughout the left lung.
- C. The patient has decreased bowel sounds in all four quadrants.
- D. The patient complains of 6/10 (0-10 scale) abdominal pain.
Correct Answer: B
Rationale: Decreased breath sounds on one side may indicate a pneumothorax, which requires rapid diagnosis and treatment. The abdominal pain and nausea also should be addressed but they 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.