Nokea
The nurse is caring for an undernourished client who recently began receiving total parenteral nutrition (TPN). Which laboratory value would indicate that the client is responding to treatment?
- A. Fasting blood glucose: 129 mg/dL (7.15 mmol/L) [70-110 mg/dL, 4.0–6.0 mmol/L]
- B. White blood cell (WBC) count: 12,000 mm3 (0.012×10⁹/L) [4,000-11,000 cells/µL,3.5–10.5 × 10⁹/L]
- C. Albumin: 3.6 g/dL [3.5-5 g/dL]
- D. Urine specific gravity: 1.040 [1.005-1.030]
Correct Answer: C
Rationale: Albumin within the normal range (3.6 g/dL) indicates improved nutritional status, a goal of TPN. Elevated glucose, WBC, and urine specific gravity suggest other issues (e.g., hyperglycemia, infection, dehydration) not directly related to TPN’s therapeutic effect.
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The nurse is caring for a client who reports excessive flatulence and abdominal cramping. The nurse anticipates a prescription for which of the following?
- A. Simethicone
- B. Omeprazole
- C. Ferrous sulfate
- D. Cimetidine
Correct Answer: A
Rationale: Simethicone reduces gas bubbles, alleviating flatulence and cramping. Omeprazole and cimetidine treat acid-related conditions, and ferrous sulfate is for anemia, not gas or cramping.
A nasogastric tube has been inserted into a client with bowel obstruction for gastric decompression. The nurse should set the suction on which setting?
- A. Intermittent suction at 70 mmHg
- B. Intermittent suction at 100 mmHg
- C. Continuous suction at 100 mmHg
- D. Continuous suction at 70 mmHg
Correct Answer: A
Rationale: Intermittent suction at 70 mmHg (A) is appropriate for gastric decompression in bowel obstruction to prevent mucosal damage while effectively removing gastric contents.
A 52-year-old client with a 20-year history of alcohol abuse is hospitalized with mild ascites, jaundice, and bruising. Imaging demonstrates the presence of esophageal varices, while the client's elevated serum ammonia level indicates hepatic encephalopathy. The nurse is concerned the client's esophageal varices may rupture and proceeds to educate the client accordingly. Which item should the nurse include in the client's education session?
- A. Do not lift heavy objects.
- B. Avoid walking briskly.
- C. Avoid taking barbiturates.
- D. Avoid ingesting antacids.
Correct Answer: A
Rationale: Avoiding heavy lifting (A) reduces intra-abdominal pressure, decreasing the risk of esophageal variceal rupture. The other options are less directly related to preventing variceal bleeding.
The nurse is caring for a client admitted with an exacerbation of Crohn's disease
Item 1 of 1
• History and Physical
A 25-year-old male has had Crohn's disease for over six years. He is admitted to the hospital for severe diarrhea, abdominal pain, and fatigue. The client will be admitted for fluid replacement, antibiotics, steroids, and pain control.
• Physician Orders
• Admit to the medical-surgical unit
• Nothing by mouth (NPO)
• Gastroenterology consultation
• Lactated Ringers at 80 mL/hr
• Metronidazole 500 mg intravenous piggyback q 8 hours
• Methylprednisolone 125 mg intravenously q 12 hours
Drag the words from the word choices below to fill in each blank of the following sentences: The prescribed------------------------------puts the client at risk for complications such as hyperglycemia. To recognize this complication the nurse should monitor the client’s------------------
- A. metronidazole
- B. lactated ringers
- C. methylprednisolone
- D. nothing by mouth status
- E. capillary blood glucose
- F. hemoglobin A1C
Correct Answer: C,E
Rationale: Methylprednisolone is a corticosteroid that may cause elevated blood glucose and even hyperglycemia (blood glucose 250 mg/dL or greater). This is a common treatment for exacerbations of inflammatory bowel disorders. Hyperglycemia may complicate outcomes by delaying wound healing and increasing the client’s risk for infection. Thus, the nurse should monitor the capillary blood glucose and collaborate with the primary healthcare provider.
Monitoring the hemoglobin A1C is useful for monitoring the clinical progress of a client with chronic diabetes. This value is collected every 90-120 days and would not be useful during this acute course of steroids.
During an exacerbation of Crohn’s disease, it is likely that the client will be prescribed antibiotics such as metronidazole. The client will also have fluid repletion, and isotonic solutions such as lactated ringers may be given to rehydrate the client.
The nurse is caring for a client diagnosed with peptic ulcer disease. The nurse anticipates a prescription for which medication?
- A. Ondansetron
- B. Diphenoxylate with atropine
- C. Famotidine
- D. Psyllium
Correct Answer: C
Rationale: Famotidine, an H2 receptor blocker, reduces gastric acid production, aiding in peptic ulcer healing. Ondansetron is for nausea, diphenoxylate-atropine for diarrhea, and psyllium for constipation, none of which treat ulcers directly.