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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.
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The nurse is caring for a patient who has been NPO during treatment for nausea and vomiting caused by gastric irritation and is to start oral intake. Which of the following menu choices should the nurse offer to the patient?
- A. A glass of orange juice
- B. A dish of lemon gelatin
- C. A cup of coffee with cream
- D. A bowl of hot chicken broth
Correct Answer: B
Rationale: Clear liquids are usually the first foods started after a patient has been nauseated. Acidic foods such as orange juice, very hot foods, and coffee are poorly tolerated when patients have been nauseated.
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.
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 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 health care provider prescribes the following therapies for a patient who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order should the nurse implement first?
- A. Infuse normal saline at 250 ml/hour.
- B. Administer IV ondansetron.
- C. Provide oral care with moistened swabs.
- D. Insert a nasogastric (NG) tube.
Correct Answer: A
Rationale: Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished as quickly as possible after the IV fluids are initiated.