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The nurse is caring for a patient with a peptic ulcer and a nasogastric (NG) tube who develops sudden, severe upper abdominal pain, diaphoresis, and a firm, rigid abdomen. Which of the following actions should the nurse take next?
- A. Irrigate the NG tube.
- B. Obtain the vital signs.
- C. Listen for bowel sounds.
- D. Give the ordered antacid.
Correct Answer: B
Rationale: The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. The nurse should assess the bowel sounds, but this is not the first action that should be taken.
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The nurse is caring for a patient with a bleeding duodenal ulcer who has a nasogastric (NG) tube in place and a prescription for 30 mL of aluminum hydroxide/magnesium hydroxide to be instilled through the tube every hour. Which of the following assessments should the nurse do to evaluate the effectiveness of this treatment?
- A. Periodically aspirate and test gastric pH.
- B. Monitor arterial blood gas values on a daily basis.
- C. Check each stool for the presence of occult blood.
- D. Measure the amount of residual stomach contents hourly.
Correct Answer: A
Rationale: The purpose for antacids is to increase gastric pH. Checking gastric pH is the most direct way of evaluating the effectiveness of the medication. Arterial blood gases may change slightly, but this does not directly reflect the effect of antacids on gastric pH. Because the patient has upper gastrointestinal (GI) bleeding, occult blood in the stools will appear even after the acute bleeding has stopped. The amount of residual stomach contents is not a reflection of resolution of bleeding or of gastric pH.
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 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 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.
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.