Nokea
All of the following prescriptions are received for a patient who has vomited 1500 mL of bright red blood. Which order will the nurse implement first?
- A. Insert a nasogastric (NG) tube and connect to suction.
- B. Administer intravenous (IV) famotidine
- C. Draw blood for type and crossmatch.
- D. Infuse 1000 mL of lactated Ringer's solution.
Correct Answer: D
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 also are important to implement quickly but are not the highest priorities.
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Which of the following information is best for the nurse to include when teaching a patient with peptic ulcer disease (PUD) about dietary management of the disease?
- A. Avoid foods that cause pain after you eat them.
- B. High-protein foods are least likely to cause pain.
- C. You will need to remain on a bland diet indefinitely.
- D. You should avoid eating many raw fruits and vegetables.
Correct Answer: A
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; however, some patients tolerate by chewing well. High-protein foods not only 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.
The nurse is caring for an older-adult patient who has been diagnosed with esophageal cancer and the patient tells the nurse, 'I know that my chances are not very good, but I do not feel ready to die yet.' Which of the following responses by the nurse is best?
- A. You may have quite a few years still left to live.
- B. Thinking about dying will only make you feel worse.
- C. Having this new diagnosis must be very hard for you.
- D. It is important that you be realistic about your prognosis.
Correct Answer: C
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 low survival rate, so the response 'You may have quite a few years still left to live' 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.
A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. Which of the following information should the nurse teach to the patient to avoid recurrence of these symptoms?
- A. Lie down for about 30 minutes after eating.
- B. Choose foods that are high in carbohydrates.
- C. Increase the amount of fluid intake with meals.
- D. Drink sugared fluids or eat candy after each meal.
Correct Answer: A
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.
The nurse is assessing the mouth of a patient who uses smokeless tobacco for signs of oral cancer. Which of the following findings is of most concern?
- A. Bleeding during tooth brushing
- B. Painful blisters at the border of the lips
- C. Red, velvety patches on the buccal mucosa
- D. White, curdlike plaques on the posterior tongue
Correct Answer: C
Rationale: A red, velvety patch suggests erythroplasia, which has a high incidence (90%) of progression to malignant cancer. The other lesions are suggestive of acute processes (gingivitis, oral candidiasis, and herpes simplex).
Which of the following information about a patient who has just been admitted to the hospital with nausea and vomiting requires the most rapid intervention by the nurse?
- A. The patient has taken only sips of water.
- 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 been vomiting several times a day for the last 4 days.
Correct 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 also is important to collect, but it does not require as quick action as the risk for aspiration.