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A patient with deep partial-thickness burns experiences severe pain associated with nausea during dressing changes. Which action will be most useful in decreasing the patient's nausea? - ✔✔Adminis... ter the prescribed morphine sulfate before dressing changes. A patient who has been NPO during treatment for nausea and vomiting caused by gastric irritation is to start oral intake. Which of these should the nurse offer to the patient? - ✔✔A dish of lemon gelatin. A patient who is receiving chemotherapy develops a Candida albicans oral infection. The nurse will anticipate the need for - ✔✔Administration of nystatin (Mycostatin) oral tablets. When the nurse is assessing the mouth of a patient who uses smokeless tobacco for signs of oral cancer, which finding will be of most concern? - ✔✔Red, velvety patches on the buccal mucosa. To decrease the risk for cancers of the tongue and buccal mucosa, which information will the nurse include when teaching a patient who is seen for an annual physical exam in the outpatient clinic? - ✔✔Avoid use of cigarettes and smokeless tobacco. The nurse is assessing a patient with gastroesophageal reflux disease (GERD) who is experiencing increasing discomfort. Which patient statement indicates that additional patient education about GERD is needed? - ✔✔"I eat small meals throughout the day and have a bedtime snack." When admitting a patient with a stroke who is unconscious and unresponsive to stimuli, the nurse learns from the patient's family that the patient has a history of gastroesophageal reflux disease (GERD). The nurse will plan to do frequent assessments of the patient's - ✔✔Breath sounds. A patient with recurring heartburn receives a new prescription for esomeprazole (Nexium). In teaching the patient about this medication, the nurse explains that this drug - ✔✔Treats gastroesophageal reflux disease by decreasing stomach acid production. After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which diet choice for a snack 2 hours before bedtime indicates that the teaching has been effective? - ✔✔Cherry gelatin and fruit A patient who recently has been experiencing frequent heartburn is seen in the clinic. The nurse will anticipate teaching the patient about - ✔✔Proton pump inhibitors. A 62-year-old patient who has been diagnosed with esophageal cancer tells the nurse, "I know that my chances are not very good, but I do not feel ready to die yet." Which response by the nurse is most appropriate? - ✔✔"Having this new diagnosis must be very hard for you." Which information will the nurse include when teaching a patient with newly diagnosed gastroesophageal reflux disease (GERD)? - ✔✔"It will be helpful to keep the head of your bed elevated on blocks." A patient has just arrived on the postoperative unit after having a laparoscopic esophagectomy for treatment of esophageal cancer. Which nursing action should be included in the postoperative plan of care? - ✔✔Elevate the head of the bed to at least 30 degrees. The nurse will plan to teach the patient with newly diagnosed achalasia that - ✔✔Endoscopic procedures may be used for treatment. A patient who is nauseated and vomiting up blood-streaked fluid is admitted to the hospital with acute gastritis. To determine possible risk factors for gastritis, the nurse will ask the patient about - ✔✔Use of nonsteroidal anti-inflammatory drugs (NSAIDs). Cobalamin injections have been prescribed for a patient with chronic atrophic gastritis. The nurse determines that teaching regarding the injections has been effective when the patient states, - ✔✔"The cobalamin injections will prevent me from becoming anemic." A patient who has had several episodes of bloody diarrhea is admitted to the emergency department. Which action should the nurse anticipate taking? - ✔✔Obtain a stool specimen for culture. A patient is hospitalized with vomiting of "coffee-ground" emesis. The nurse will anticipate preparing the patient for - ✔✔Endoscopy. A 22-year-old patient with Escherichia coli O157:H7 food poisoning is admitted to the hospital with bloody diarrhea and dehydration. All of the following orders are received. Which order will the nurse question? - ✔✔Administer loperamide (Imodium) after each stool. The health care provider orders intravenous (IV) ranitidine (Zantac) for a patient with gastrointestinal (GI) bleeding caused by peptic ulcer disease. When teaching the patient about the effect of the medication, which information will the nurse include? - ✔✔"Ranitidine decreases secretion of gastric acid." The family member of a patient who has suffered massive abdominal trauma in an automobile accident asks the nurse why the patient is receiving famotidine (Pepcid). The nurse will explain that the medication will - ✔✔Inhibit the development of stress ulcers. A patient with a bleeding duodenal ulcer has a nasogastric (NG) tube in place, and the health care provider orders 30 mL of aluminum hydroxide/magnesium hydroxide (Maalox) to be instilled through the tube every hour. To evaluate the effectiveness of this treatment, the nurse - ✔✔Periodically aspirates and tests gastric pH. patient with a peptic ulcer who has a nasogastric (NG) tube develops sudden, severe upper abdominal pain, diaphoresis, and a very firm abdomen. Which action should the nurse take next? - ✔✔Obtain the vital signs. Twelve hours after undergoing a gastroduodenostomy (Billroth I), a patient complains of increasing abdominal pain. The patient has absent bowel sounds and 200 mL of bright red nasogastric (NG) drainage in the last hour. The most appropriate action by the nurse at this time is to - ✔✔Notify the surgeon. The nurse implements discharge teaching for a patient following a gastroduodenostomy for treatment of a peptic ulcer. Which patient statement indicates that the teaching has been effective? - ✔✔"Vitamin supplements may be needed to prevent problems with anemia." A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. To avoid recurrence of these symptoms, the nurse teaches the patient to - ✔✔lie down for about 30 minutes after eating. A patient who requires daily use of a nonsteroidal anti-inflammatory drug (NSAID) for management of severe rheumatoid arthritis has recently developed melena. The nurse will anticipate teaching the patient about - ✔✔The benefits of misoprostol (Cytotec) in protecting the gastrointestinal (GI) mucosa. The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. The nurse will teach the patient to take - ✔✔Antacids after eating and sucralfate 30 minutes before eating. Which information will be best for the nurse to include when teaching a patient with peptic ulcer disease (PUD) about dietary management of the disease? - ✔✔"Avoid foods that cause pain after you eat them." A patient with a recent 20-pound unintended weight loss is diagnosed with stomach cancer. Which nursing action will be included in the plan of care? - ✔✔Offer supplemental feedings between meals. When counseling a patient with a family history of stomach cancer about ways to decrease risk for developing stomach cancer, the nurse will teach the patient to avoid - ✔✔Smoked foods such as bacon and ham. Which assessment finding in a patient who had a total gastrectomy 12 hours previously is most important to report to the health care provider? - ✔✔Temperature 102.1° F (38.9° C) Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse? - ✔✔The patient is lethargic and difficult to arouse. Which of these nursing actions should the RN working in the emergency department delegate to nursing assistive personnel who help with the care of a patient who has been admitted with nausea and vomiting? - ✔✔Assist the patient with oral care after vomiting. 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 will the nurse implement first? - ✔✔Infuse normal saline at 250 mL/hr. After receiving change-of-shift report, which patient should the nurse assess first? - ✔✔A patient with esophageal varices who has a blood pressure of 96/54 mm Hg Which of these assessment findings 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? - ✔✔The patient has absent breath sounds throughout the left lung. A patient who is vomiting bright red blood is admitted to the emergency department. Which assessment should the nurse perform first? - ✔✔Taking the blood pressure (BP) and pulse All of the following orders are received for a patient who has vomited 1500 mL of bright red blood. Which order will the nurse implement first? - ✔✔Infuse 1000 mL of lactated Ringer's solution. A patient with acute gastrointestinal (GI) bleeding is receiving normal saline IV at a rate of 500 mL/hr. Which assessment finding obtained by the nurse is most important to communicate immediately to the health care provider? - ✔✔The patient's lungs have crackles audible to the midline. When caring for a preoperative patient on the day of surgery, which actions included in the plan of care can the nurse delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) a. Teach incentive spirometer use. b. Explain preoperative routine care. c. Obtain and document baseline vital signs. d. Remove nail polish and apply pulse oximeter. e. Transport the patient by stretcher to the operating room - ✔✔ANS: C, D, E Obtaining vital signs, removing nail polish, pulse oximeter placement, and transport of the patient are routine skills that are appropriate to delegate. Teaching patients about the preoperative routine and incentive spirometer use require critical thinking and should be done by the registered nurse [Show More]

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