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During change-of-shift report, the nurse receives the following information about a patient who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure?
- A. The patient has a permanent pacemaker to prevent bradycardia.
- B. The patient is worried about discomfort during the examination.
- C. The patient has had an allergic reaction to shellfish and iodine in the past.
- D. The patient refused to drink the ordered polyethylene glycol.
Correct Answer: D
Rationale: If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication to magnetic resonance imaging (MRI), but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patient's anxiety about discomfort.
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The health care provider sees a patient at 10 A.M. and writes a prescription for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which of the following actions that are included in the agency protocol for ERCP should the nurse take first?
- A. Place the patient on NPO status.
- B. Administer sedative medications.
- C. Ensure the consent form is signed.
- D. Explain the procedure to the patient.
Correct Answer: A
Rationale: The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse's initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO.
The nurse is preparing to assess a patient's liver. When palpating the liver, which of the following techniques should the nurse implement?
- A. Place one hand on the patient's back and press upward and inward with the other hand below the patient's right costal margin.
- B. Place one hand on top of the other and use the upper fingers to apply pressure and the bottom fingers to feel for the liver edge.
- C. Press slowly and firmly over the right costal margin with one hand and withdraw the fingers quickly after the liver edge is felt.
- D. Place one hand under the patient's lower ribs and press the left lower rib cage forward, palpating below the costal margin with the other hand.
Correct Answer: A
Rationale: The liver is normally not palpable below the costal margin, the nurse needs to push inward below the right costal margin while lifting the patient's back slightly with the left hand. The other methods will not allow palpation of the liver.
The nurse is caring for a patient who has just had a colonoscopy. Which of the following symptoms should alert the nurse that a perforation has occurred?
- A. Malaise
- B. Abdominal distension
- C. Hypertension
- D. Bradycardia
- E. Tenesmus
Correct Answer: A,B,E
Rationale: Following a colonoscopy the nurse should observe the patient for rectal bleeding and signs of perforation (e.g. malaise, abdominal distension, tenesmus). Hypertension and bradycardia are not typical signs of perforation.
Which of the following information obtained by the nurse when admitting a patient who is scheduled for an ultrasound of the gallbladder indicates that the ultrasound may need to be rescheduled?
- A. The patient has a permanent gastrostomy tube.
- B. The patient took a laxative the previous evening.
- C. The patient ate a low-fat bagel an hour previously.
- D. The patient had a high-fat meal the previous evening.
Correct Answer: C
Rationale: Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8-12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study.
Which of the following actions by a nursing student when caring for a patient who has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD) requires that the RN intervene?
- A. Offering the patient a glass of water
- B. Positioning the patient on the right side
- C. Checking the vital signs every 30 minutes
- D. Swabbing the patient's mouth with cold water
Correct Answer: A
Rationale: Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. The patient should be NPO for 2-4 hours. Assessment for return of the gag reflex should be done prior to administering any fluids by mouth. The other actions by the student are appropriate.