Nokea
The health care provider prescribes antacids and sucralfate for treatment of a patient's peptic ulcer. Which of the following information should the nurse include in the patient's teaching plan?
- A. Antacids 30 minutes before the sucralfate
- B. Sucralfate at bedtime and antacids before meals
- C. Antacids after eating and sucralfate 30 minutes before eating
- D. Sucralfate and antacids together 30 minutes before each meal
Correct Answer: C
Rationale: Sucralfate is most effective when the pH is low and should not be given with or soon after antacid. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.
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The nurse is admitting a patient to the emergency department who has had several episodes of bloody diarrhea. Which of the following actions should the nurse anticipate taking?
- A. Obtain a stool specimen for culture.
- B. Administer antidiarrheal medications.
- C. Teach about adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs).
- D. Provide education about antibiotic therapy.
Correct Answer: A
Rationale: Patients with bloody diarrhea should have a stool culture for E. coli O157:H7. NSAIDs may cause occult blood in the stools, but not diarrhea. Antidiarrheal medications usually are avoided for possible infectious diarrhea to avoid prolonging the infection. Antibiotic therapy in the treatment of infectious diarrhea is controversial because it may precipitate kidney complications.
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 health care provider prescribes the following therapies for a patient who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order should the nurse implement first?
- A. Infuse normal saline at 250 ml/hour.
- B. Administer IV ondansetron.
- C. Provide oral care with moistened swabs.
- D. Insert a nasogastric (NG) tube.
Correct Answer: A
Rationale: Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished as quickly as possible after the IV fluids are initiated.
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.
Which of the following information should the nurse plan to teach to a patient with newly diagnosed achalasia?
- A. A liquid or blenderized diet will be necessary.
- B. Drinking fluids with meals should be avoided.
- C. Endoscopic procedures may be used for treatment.
- D. Lying down and resting after meals is recommended.
Correct Answer: C
Rationale: Endoscopic and laparoscopic procedures are the most effective therapy for improving symptoms caused by achalasia. Patients are advised to drink fluid with meals. Keeping the head elevated after eating will improve esophageal emptying. A semisolid diet is recommended to improve esophageal emptying.