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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.
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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.
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.
The nurse is caring for a patient with acute gastrointestinal (GI) bleeding who is receiving normal saline IV at a rate of 500 ml/hour. Which of the following findings obtained by the nurse is most important to communicate immediately to the health care provider?
- A. The patient's blood pressure (BP) has increased to 142/94 mm Hg.
- B. The nasogastric (NG) suction is returning coffee-ground material.
- C. The patient's lungs have crackles audible to the midline.
- D. The bowel sounds are very hyperactive in all four quadrants.
Correct Answer: C
Rationale: The patient's lung sounds indicate that pulmonary edema may be developing as a result of the rapid infusion of IV fluid and that the fluid infusion rate should be slowed. The return of the coffee-ground material in an NG tube is expected for a patient with upper GI bleeding. The BP is slightly elevated but would not be an indication to contact the health care provider immediately. Hyperactive bowel sounds are common when the patient has GI bleeding.
The nurse is assessing the mouth of a patient who uses smokeless tobacco for signs of oral cancer. Which of the following findings is of most concern?
- A. Bleeding during tooth brushing
- B. Painful blisters at the border of the lips
- C. Red, velvety patches on the buccal mucosa
- D. White, curdlike plaques on the posterior tongue
Correct Answer: C
Rationale: A red, velvety patch suggests erythroplasia, which has a high incidence (90%) of progression to malignant cancer. The other lesions are suggestive of acute processes (gingivitis, oral candidiasis, and herpes simplex).
Which of the following findings should the nurse anticipate in a patient with an upper GI bleed?
- A. Increased urinary output
- B. Black, tarry stool
- C. Constipation
- D. Diaphoresis
- E. Epigastric pain
Correct Answer: B,D,E
Rationale: A patient with an upper GI bleed may have a black tarry stool, diaphoresis, and epigastric pain. The patient would have complaints of diarrhea, not constipation. The patient would have a decreased urinary output, not an increased one.