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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.
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The nurse is assessing a patient who recently has been experiencing frequent 'heartburn' in the clinic. Which of the following information should the nurse include in the teaching plan?
- A. Barium swallow
- B. Radionuclide tests
- C. Endoscopy procedures
- D. Proton pump inhibitors
Correct Answer: D
Rationale: Because diagnostic testing for heartburn that is probably caused by gastroesophageal reflux disease (GERD) is expensive and uncomfortable, proton pump inhibitors are frequently used for a short period as the first step in the diagnosis of GERD. The other tests may be used but are not usually the first step in diagnosis.
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.
The nurse is teaching a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications. Which of the following diet choices for a snack 2 hours before bedtime indicates that the teaching has been effective?
- A. Chocolate pudding
- B. Glass of low-fat milk
- C. Peanut butter sandwich
- D. Cherry gelatin and fruit
Correct Answer: D
Rationale: Cherry gelatin and fruit is a suitable choice as it is low in fat and not likely to trigger reflux, unlike chocolate, milk, or high-fat foods like peanut butter, which can exacerbate GERD symptoms.
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 teaching a patient with gastroesophageal reflux disease (GERD) about the medication omeprazole. Which of the following information should the nurse include when teaching the patient about this medication?
- A. It neutralizes stomach acid and provides relief of symptoms in a few minutes.
- B. It reduces the reflux of gastric acid by increasing motility.
- C. It coats and protects the lining of the stomach and esophagus from gastric acid.
- D. It treats gastroesophageal reflux disease by decreasing stomach acid production.
Correct Answer: D
Rationale: Omeprazole is a proton pump inhibitor that decreases the rate of gastric acid secretion. Promotility drugs such as metoclopramide increase the rate of gastric emptying. Cytoprotective medications such as sucralfate protect the stomach. Antacids neutralize stomach acid and work rapidly.