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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.
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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.
Which of the following symptoms should the nurse anticipate in a patient with a duodenal ulcer?
- A. Decreased gastric secretion
- B. Nausea and vomiting
- C. Pain about 1 hour after a meal
- D. Middle of the night pain
- E. Relief from pain with administration of an antacid
Correct Answer: B,D,E
Rationale: A patient with a duodenal ulcer may have nausea and vomiting, pain in the middle of the night, and relief from pain with an administration of an antacid. Decreased gastric secretion is not typical; duodenal ulcers are often associated with increased acid secretion.
The nurse is assessing a patient with gastroesophageal reflux disease (GERD) who is experiencing increasing mid-epigastric discomfort. Which of the following patient statements indicate that additional patient education about GERD is needed?
- A. I take antacids between meals and at bedtime each night.
- B. I sleep with the head of the bed elevated on 10-cm blocks.
- C. I quit smoking several years ago, but I still chew a lot of gum.
- D. I eat small meals throughout the day and have a bedtime snack.
Correct Answer: D
Rationale: GERD is exacerbated by eating late at night, and the nurse should plan to teach the patient to avoid eating at bedtime. The other patient actions are appropriate to control symptoms of GERD.
The nurse is caring for a patient who is receiving chemotherapy and develops Candida albicans oral infection. Which of the following actions should the nurse anticipate?
- A. Hydrogen peroxide rinses
- B. The use of antiviral agents
- C. Referral to a dentist for professional tooth cleaning
- D. Administration of nystatin oral tablets
Correct Answer: D
Rationale: Candida albicans is treated with an antifungal such as nystatin. Oral saltwater rinses may be used but will not cure the infection. Antiviral agents are used for viral infections such as herpes simplex. Referral to a dentist is indicated for gingivitis but not for Candida infection.
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.