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The family member of a patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine. Which of the following information should the nurse provide to the family about the medication for this patient?
- A. It prevents aspiration of gastric contents.
- B. It inhibits the development of stress ulcers.
- C. It lowers the chance for H. pylori infection.
- D. It decreases the risk for nausea and vomiting.
Correct Answer: B
Rationale: Famotidine is administered to prevent the development of physiological stress ulcers, which are associated with a major physiological insult such as massive trauma. Famotidine does not decrease nausea or vomiting, prevent aspiration, or prevent H. pylori infection.
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The nurse is caring for a patient with vomiting of 'coffee-ground' emesis. Which of the following procedures should the nurse anticipate for the patient?
- A. Endoscopy
- B. Angiography
- C. Gastric analysis testing
- D. Barium contrast studies
Correct Answer: A
Rationale: Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding.
The nurse is caring for a patient with peptic ulcer disease associated with the presence of Helicobacter pylori and is being treated with triple drug therapy. Which of the following medications should the nurse include in the patient teaching?
- A. Sucralfate, nystatin, and bismuth
- B. Amoxicillin, clarithromycin, and omeprazole
- C. Famotidine, magnesium hydroxide, and pantoprazole
- D. Metoclopramide, bethanechol, and promethazine
Correct Answer: B
Rationale: The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.
The health care provider prescribes intravenous (IV) pantoprazole for a patient with gastrointestinal (GI) bleeding caused by peptic ulcer disease. When teaching the patient about the effect of the medication, which of the following information should the nurse include?
- A. Pantoprazole inhibits some of the stomach cells from pumping stomach acid.
- B. Pantoprazole neutralizes the acid in the stomach.
- C. Pantoprazole constricts the blood vessels in the stomach and decreases bleeding.
- D. Pantoprazole covers the ulcer with a protective material that promotes healing.
Correct Answer: A
Rationale: Pantoprazole is a proton pump inhibitor, which inhibits some of the stomach cells from pumping gastric acid. The response beginning, 'Pantoprazole constricts the blood vessels' describes the effect of vasopressin. The response beginning 'Pantoprazole neutralizes the acid' describes the effect of antacids. And the response beginning 'Pantoprazole covers the ulcer' describes the action of sucralfate.
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.
The nurse is caring for a patient with deep partial-thickness burns who is anxious about the upcoming dressing change, is in severe pain, and is nauseated. Which of the following actions will be most useful in decreasing the patient's nausea?
- A. Keep the patient NPO for 2 hours before and after dressing changes.
- B. Avoid performing dressing changes close to the patient's mealtimes.
- C. Administer the prescribed morphine sulphate before dressing changes.
- D. Give the ordered prochlorperazine before dressing changes.
Correct Answer: C
Rationale: The patient's nausea is associated with stress and severe pain, therefore the best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea or vomiting that occurs at other times also should be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient's nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain.