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Which of the following information should the nurse include when teaching a patient with newly diagnosed gastroesophageal reflux disease (GERD)?
- A. Peppermint tea may be helpful in reducing your symptoms.
- B. You should avoid eating between meals to reduce acid secretion.
- C. Vigorous physical activities may increase the incidence of reflux.
- D. It will be helpful to keep the head of your bed elevated on blocks.
Correct Answer: D
Rationale: Elevating the head of the bed will reduce the incidence of reflux while the patient is sleeping. Peppermint will lower LES pressure and increase the chance for reflux. Small, frequent meals are recommended to avoid abdominal distension. There is no need to make changes in physical activities because of GERD.
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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 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).
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.
Which of the following information about a patient who has just been admitted to the hospital with nausea and vomiting requires the most rapid intervention by the nurse?
- A. The patient has taken only sips of water.
- B. The patient is lethargic and difficult to arouse.
- C. The patient's chart indicates a recent resection of the small intestine.
- D. The patient has been vomiting several times a day for the last 4 days.
Correct Answer: B
Rationale: A lethargic patient is at risk for aspiration, and the nurse will need to position the patient to decrease aspiration risk. The other information also is important to collect, but it does not require as quick action as the risk for aspiration.
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.