Nokea
How will the nurse counsel the 34-year-old woman who has been prescribed sulfasalazine for Crohn disease?
- A. Expose her to sunlight at least 30 minutes a day for vitamin D synthesis.
- B. Tell her to drink at least 1500 mL of fluid a day.
- C. Advise assessing self for rash.
- D. Use alternate birth control methods to oral contraception.
- E. Take drug on an empty stomach.
Correct Answer: B,C,D
Rationale: Cautionary information about sulfasalazine include having adequate fluid intake to prevent crystallization in the kidneys, avoiding exposure to the sun, and using alternate birth control methods as oral contraception is made unreliable by this drug. The drug should be taken with meals and the patient should be assessing for rash.
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The nurse anticipates that the patient who has had a subtotal gastrectomy will need which type of supplement?
- A. protein due to the loss of some of the digestive processes.
- B. vitamin B12 due to the loss of the intrinsic factor.
- C. bulk to prevent constipation.
- D. vitamin A due to the loss of the gastric lining.
Correct Answer: B
Rationale: It is recommended that all patients with a gastrectomy have a blood serum vitamin B12 level measured every 1 to 2 years. Decreased absorption of vitamin B12 may cause pernicious anemia.
Which will be the most helpful nursing intervention to increase the comfort of a patient with appendicitis?
- A. Applying of ice bag
- B. Administration of small tap water enema
- C. Warm compress over entire abdomen
- D. Ambulate for short periods in the room
Correct Answer: A
Rationale: Applying of an ice bag will decrease the flow of blood to the area and impede the inflammatory process.
Which activities should the home health nurse suggest to an older adult patient to avoid constipation?
- A. Schedule toileting after meals
- B. Taking bulk-forming laxatives
- C. Increasing fiber intake
- D. Drinking at least 1000 mL fluid
- E. Taking a daily stool softener
- F. Using tap water enemas for persons with altered mobility
Correct Answer: A,B,C,D
Rationale: Inactivity and changes in diet and fluid intake can contribute to constipation. A nutritional diet high in fiber and bulk-forming foods can promote normal elimination. Increasing fluids to 8 to 10 glasses per day will be beneficial in preventing constipation. A daily bowel routine will also benefit elimination. Use of daily stool softeners is no longer recommended for the older adult. Tap water enemas for persons with altered mobility are not routine.
The patient with irritable bowel syndrome tells the home health nurse she is going to an acupuncturist for therapy for her condition. Which will be the best nursing response?
- A. Go for it. Alternative medicine does great things.'
- B. YIKES! An acupuncturist?'
- C. Some people have found relief from nausea and colon muscle spasms.'
- D. You should confirm that the acupuncturist and facility are state licensed.'
Correct Answer: C
Rationale: Some people find that acupuncture provides relief from nausea, vomiting and relaxation of muscle spasms in the colon. However, clinical trial data are inadequate to determine efficacy.
The nurse caring for a patient with a peptic ulcer who has had a nasogastric tube inserted notes bright blood in the tube, the patient complains of pain and has become hypotensive. Which condition should the nurse recognize these as signs of?
- A. Hiatal hernia
- B. Gastritis
- C. Perforation
- D. Bowel obstruction
Correct Answer: C
Rationale: Perforation of the gastric wall causes pain, hypotension, and hematemesis. Immediate reporting to the charge nurse/physician is essential as peritonitis, potentially lethal, is the result of a perforation.