NR 324 - Adult Health I Week 5 Edapts (100% CORRECT ANSWERS)

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Week 5: Altered Nutrition and Altered Gastrointestinal Function Nursing Care: Altered Nutrition and Gastrointestinal Function Prepare: The Nursing Care of Altered Nutrition and Gastrointestinal Func... tion Dietary Customs Idan, a 34-year-old client, has been admitted for a bowel obstruction. In the admission assessment, Idan identifies himself as a practicing Jewish man who follows Kosher dietary practices. Which statement, made by the nurse, is most appropriate? “Your family can cook your food at home and bring it to you.” “You will be NPO for now, so we can discuss your diet later.” “I will document your preferences in your chart.” “While in the hospital, you will not be able to follow Kosher practices.” Obesity Obesity impacts which body systems? Select all that apply. Cardiovascular Musculoskeletal Respiratory Reproductive Endocrine Metabolic Syndrome Which health problems are associated with metabolic syndrome? Select all that apply. Low lipid levels High blood glucose Infertility Hypertension Osteoarthritis Self-Check: Kosher Foods Idan is now post-operative day (POD) 3 from his bowel obstruction. He currently has a nasogastric (NG) tube for nutrition and medication intake. The healthcare provider has ordered enteral feeding be initiated, but Idan is concerned about the formula not following Kosher dietary practices. Which statement made by the nurse is most appropriate? “Enteral formulas are usually Kosher prepared, I will check to make sure.” “You aren’t actually drinking the formula, so Kosher rules do not apply.” “You don’t need to follow Kosher rules when you’re sick.” “I will call the healthcare provider to switch your order for parenteral nutrition instead.” Self-Check: Behavioral or Lifestyle Modifications The nurse is attending a community event for obese adults who are about to begin behavior and lifestyle modifications to lose weight. Which action is most appropriate? Discuss the benefits of eating frequent small meals throughout the day instead of scheduled mealtimes Encourage the clients to plan rewards, such as sugarless candy, for achieving their weight loss and exercise goals Ask the clients what types of situations or emotions make them want to eat/increases their appetite Self-Check: Carol's Case Study BMI Carol Hiller: 48-year-old female Allergies: Latex Weight: 158.7 kg Height: 5’ 4” Past Medical History: Asthma, diabetes mellitus type 2, gastroesophageal reflux disease (GERD) , hypertension Calculate Carol’s body mass index (BMI). Which category does she fall in to? Underweight Normal weight Overweight Obese Extreme obesity Nursing Diagnosis Carol has come to the healthcare provider’s office for a physical. The healthcare provider asks Carol about her weight and begins to discuss the correlation between her health concerns and excessive fat. Carol states that the only reason she is her current weight is due to her genetics and has nothing to do with her food intake or lack of exercise. Which nursing diagnosis is most appropriate for Carol? Increased social isolation Disturbed body image Ineffective coping Pre-Operative Nursing Care A few months have passed, and Carol has made the decision to undergo a sleeve gastrectomy. She has arrived at the pre- operative holding area to await her surgery. Carol must use the bathroom and has pressed her call button for help. The nurse and a student nurse have arrived and are preparing to help Carol. Which statement made by the student nurse requires immediate correction? “Is Carol allowed to stand before surgery?” “We can’t help move her alone! I’m getting 5 more staff members for this.” “I will get the unlicensed assistive personnel (UAP) to help her.” “I am going to get Carol some nonskid socks from the supply closet.” Reflect: The Nursing Care of Altered Nutrition and Gastrointestinal Function Delegation The nurse is preparing for Carol’s arrival to the medical surgical unit from the post anesthesia care unit (PACU). Which tasks could the nurse delegate to an unlicensed assistive personnel (UAP)? Select all that apply. Obtain compression socks Stock the room with a bariatric gown and large adult blood pressure cuff Place an NPO sign at the head of the bed Create a passive range of motion schedule for Carol Plan of Care Carol returns to the medical-surgical unit after her sleeve gastrectomy procedure. She currently has a nasogastric (NG) tube connected to low, intermittent suction. Which nursing actions are appropriate? Select all that apply. Encourage coughing and deep breathing Encourage early ambulation Frequent irrigation of the nasogastric tube Administration of pain medications as prescribed Offer 30mL of fruit juices every 2 hours Post-Operative Nursing Care The nurse goes into Carol’s room to assess her abdominal surgical incision. Carol is complaining of incisional pain, and the nurse notices slight erythema at the incision edges. Her current vital signs are as follows: ● Temperature 99.9º F ● Blood pressure 124/76 ● Heart rate 84, regular ● Respiratory rate 16 breaths per minute The nurse recognizes that this is part of the normal healing process, but is concerned about which barrier to healing? Select all that apply. Carol’s type 2 diabetes mellitus Carol’s extra skin folds and abdominal weight Where the surgeon placed the incision Carol’s incisional pain Communication Carol is in her room on the medical surgical unit when the unlicensed assistive personnel (UAP) arrives to take her vital signs. The UAP reports the vital signs to the nurse and mentions that Carol appears upset and tearful in her bed. Her vital signs are as follows: ● Blood pressure 178/98 ● Temperature 99.9 degrees F ● Heart rate 106, regular ● Respiratory rate 18 breaths per minute ● Pain 9/10 , but states “I’ll be fine” The nurse approaches Carol in her room. Carol says, “I’m so sorry, I know I must be a bother to you. I know caring for me can be more complicated because of my size. I’m okay, though. Thank you for checking on me, I’m fine for right now.” Which action made by the nurse is most appropriate? Thank Carol and leave her room quietly, putting her call light next to her Remind Carol that she had bariatric surgery, so her size won’t be a problem anymore Sit with Carol and ask about the pain she is experiencing Ask Carol how she handled being obese before her surgery Teaching The nurse is preparing to provide Carol with discharge teaching. Which information will the nurse plan to include? Support groups should be initiated one year post-operatively Drink fluids before or after mealtimes Include high fat foods for 35% of total daily intake Exercise programs can be discontinued Long-Term Goal What would an appropriate long-term goal be for Carol? Select all that apply. Join a community support group Maintain daily physical exercise program Begin a low carbohydrate/high protein / low fat diet with one ‘cheat day’ per week Be free from signs of malnutrition Attain her goal weight within 8 months of her surgery Dietary Preferences Idan is asking the nurse about potential changes in his dietary preferences so his bowel obstruction does not reoccur. The nurse recognizes that they have deficient knowledge regarding Kosher dietary preferences and is unsure of how to respond to Idan. Which is the most appropriate action? The nurse asks their Jewish colleague to come and talk to Idan instead. The nurse excuses themselves to read an internet article on Kosher food preparation to answer Idan’s question. Tell Idan since his bowel obstruction was surgically corrected, it cannot reoccur. The nurse asks Idan to explain Kosher preferences to them. Dietary Intake When discussing appropriate daily nutritional intake, which proportions are correct? Malnutrition Prepare: Malnutrition Risk Factors What are conditions that increase a client's risk of developing malnutrition? Select all that apply. Depression Dysphagia Current infection Dialysis Excessive dieting to lose weight Enteral Nutrition What is a characteristic of enteral nutrition? It is administered through a tube, stoma, or catheter It is provided to client's who's gastrointestinal (GI) tract is not intact It is administered through a central venous catheter Nursing Care Enteral Nutrition What is the importance of raising the client's head of bed prior to administering enteral nutrition? To reduce the risk of the client aspirating To help the client taste the nutrition for a better experience To put the client in a more natural eating position Self-Check: Assessment You are completing a nutritional assessment on a newly admitted client. Which of the following questions are most important to ask? Select all that apply. Have you recently gained or lost weight? Do you participate in programs such as meals on wheels? How much do you sleep at night? Do you take any medications? Do you wear dentures and do they fit comfortably? Self-Check: Assessments Eric, a 67-year-old male client, has suffered a large ischemic stroke. He is currently dysphagic and lethargic, so a percutaneous gastrostomy (PEG) tube was ordered for nutritional support. His wife, Lydia, is asking questions regarding the rationale for the PEG tube. Which response by the nurse is best? "It is not safe for Eric to have any oral intake right now because of his lethargy and inability to safely swallow, so this is a safe option for his nutrition." "Eric's gastrointestinal system is no longer working on its own, so the PEG tube will allow him to still get nutrition.” "He will not be able to go to the nursing home or rehab after discharge without a PEG tube.” Self-Check: Post-Operative Tube Insertion Eric has returned from the operating room with a percutaneous gastrostomy (PEG) tube. He currently has 50mL/hour of IV lactated Ringer's solution running. Nothing is infusing in the PEG tube. Which action should the nurse implement? Select all that apply. Continue to monitor without infusing anything into the PEG tube at this time Assess the incisional dressing Auscultate for bowel sounds Call dietary to have them deliver enteral nutritional formula as soon as possible Connect the lactated Ringer's solution to the PEG tube for administration Self-Check: Gastrointestinal Obstruction Robin is admitted with a gastrointestinal obstruction. Which of the following options is best for Robin to receive nutritional support? Enteral nutrition (EN) Oral intake Parenteral nutrition (PN) Dextrose 5% in 0.9% saline infusion Self-Check: Assessments Robin has a peripherally inserted central catheter (PICC) placed for her parenteral nutrition. Which of the following assessments would be appropriate for the nurse to include in Robin's plan of care? Select all that apply. Thorough respiratory assessments Assess blood glucose levels Catheter site assessments Rotate IV site every 72 hours Daily weights Maintain accurate intake and output Self-Check: Types of Nutritional Support Match the information to the appropriate type of nutritional support . Reflect: Malnutrition Delegation The nurse is attempting to delegate activities and interventions to other members on the team. Which of the following actions is inappropriately delegated to the correct person? Maria, LPN, who will remove a client's nasogastric tube John, RN, who will develop a plan of care for a malnourished client Joy, LPN, who will give medications to a stable client through a PEG tube Eve, UAP, who will educate the client about PEG tube care Nursing Care The nurse is preparing to care for Eric with the assistance of a student nurse. Which action by the student nurse will require the nurse to step in? The student checked for residual. The student crushed the tablet medications and mixed them with water for administration. The student assessed for bowel sounds prior to feeding. The student lowered the client's head of bed below 30 degrees when preparing to administer medications. Nursing Care Eric and his wife Lydia are prepping for discharge. Match the interprofessional team member with their role in helping Eric and Lydia. Click on an item in the first column, then click on the matching item in the second column. Complications The nurse is writing a priority nursing diagnosis for Robin. Create the nursing diagnosis below. Complications The nurse notices that Robin's parenteral nutrition bag has run dry, and a new one has not been prepared and sent from pharmacy. Which complication is the nurse anticipating? Hypoglycemia Hyperglycemia Hypertension Hypotension Nursing Care Since the nurse has recognized that Robin is now at an increased risk for hypoglycemia, which of the following orders is most important to implement? Initiate 10% dextrose solution IV Check blood glucose at bedside every 2 hours Initiate 0.9% sodium chloride bolus of 500mL Administer acetaminophen 325 mg PO Nursing Care Case management is discussing the potential of discharging Robin home with her parenteral nutrition and peripherially inserted central cathether (PICC) line in place. Which of the following assessments would be most beneficial in determining Robin's readiness to return home at this time? Select all that apply. Let Robin list the reasons to contact the physician after discharge, like developing a fever, severe pain around her PICC line, or shortness of breath. Discuss the need for Robin to mix her parenteral nutrition in the bathroom. Let Robin demonstrate how self-administer her parenteral nutrition. Have Robin discuss the need to leave her parenteral nutrition formula out of the refrigerator for 2 hours prior to administration. Home Care Which of the following is a priority concern for Robin while at home? Sleep deprivation Hypotension Infection GERD Prepare: GERD Lower Esophageal Sphincter Where is the lower esophageal sphincter? 1 2 3 4 5 Manifestations What are common manifestations of gastroesophageal reflux disease? Select all that apply. Hypertension Urinary retention Dyspepsia Vomiting Pyrosis Drug Therapy Which of the following prescriptions is commonly administered for gastroesophageal reflux disease (GERD)? carvedilol oxycodone famotidine mesalamine Self-Check: Risk Factors What are some risk factors commonly associated with the development of GERD? Select all that apply. Obesity Hiatal hernias Heart disease Smoking Diabetes Mellitus Self-Check: Meet Rebecca Rebecca, a 58 year old female with a history of hypertension and arthritis, has arrived to the emergency department (ED) for symptoms of chest pain. She was finishing dinner with her husband, Ron, when the symptoms started. Rebecca took a calcium carbonate tablet while enroute to the ED, and took her hypertensive medications this morning as prescribed. Which of the following questions would best alert the nurse to the possible cause of Rebecca’s chest pain? “Have you been recently ill?” “Is your chest pain better since taking the calcium carbonate?” “What did you have at dinner?” “Do you have a family history of heart disease?” Self-Check: Risk Factors Jeff is a 64 year old retired contractor with gastroesophageal reflux disease (GERD). He has smoked 1.5 packs of cigarettes a day for 30 years (equaling a 45 pack year history), drinks “one or two glasses of whiskey at night”, and loves tomato soup. His BMI is 39. What lifestyle changes can Jeff make to decrease his symptoms of GERD? Select all that apply. Eating small, frequent meals Smoking cessation Avoiding foods that cause reflux Decreasing daily fluid intake Increase calories to gain weight Self-Check: Post Procedure Rebecca has just returned from an endoscopy to evaluate for gastroesophageal reflux disease (GERD) and is asking for ice chips. Which of the following assessments is the nurse’s priority? Monitoring laboratory values for signs of dehydration Assessing the client’s blood pressure Return of the client’s gag reflex Last time the client had something to eat Self-Check: Lifestyle Changes Rebecca has been diagnosed with gastroesophageal reflux disease (GERD). She is concerned about the lifestyle changes that she will need to implement in order to maintain her symptoms. Which of the following recommendations would be most beneficial for Rebecca? Ask the healthcare provider to change Rebecca’s prescriptions to options that don’t need to be taken daily . Remind Rebecca that she has technology that can help her, like reminders set or alarms on her personal cell phone or devices. Involve her husband, Ron, in the client education. Inform Rebecca that she will need surgery if she does not modify her lifestyle choices. Reflect: GERD Diet Jeff just had his meal tray delivered to his room. Which of the following food choices would the nurse see as an opportunity for client teaching? Medication Schedule Rebecca has been discharged from the hospital with a new list of home medications. The healthcare provider prescribed 40mg of pantoprazole for her gastroesophageal reflux disease (GERD) symptoms. Select the proper slot in Rebecca’s datebook to schedule her dose of pantoprazole. Post Discharge Help Rebecca’s husband, Ron, mentions that Rebecca has been unable to sleep recently due to her heartburn and dyspepsia, and asks how he can help her get comfortable when they are home. Which of the following recommendations should the nurse provide? Make Rebecca her favorite nighttime snack right before bed. Offer an extra pillows for Rebecca to sleep on. Remind Rebecca she needs to lay down after eating to help her heartburn. Give Rebecca a glass of wine before bed. Post Operative Jeff has returned to the nursing unit after a Nissen fundoplication. He has an indwelling urinary catheter, a nasogastric (NG) tube to low continuous suction, and two IVs. Jeff is alert and oriented with a 4/10 pain score on the 0-10 scale. The nurse notes bright red blood in the NG tube. What action should the nurse take first? Document the findings it the chart. Take a full set of vital signs. Reassess the drainage in 60 minutes. Notify the surgeon immediately. Drug Therapy Rebecca is asking the nurse why she was prescribed pantoprazole. In teaching her about this medication, the nurse explains that this drug: Reduces the reflux of gastric acid by increasing the rate of gastric emptying Decreases stomach acid production Coats and protects the lining of the stomach from hydrochloric acid Can be taken PRN Pantoprazole A few months after discharge, Rebecca returns to the hospital and has developed watery diarrhea and a fever after prolonged pantoprazole therapy. In which order will the nurse complete the following actions? Drag and Drop the interventions into the highest priority to the lowest priority. 1. Place Rebecca on contact precautions. 2. Assess Rebecca’s blood pressure and heart rate. 3. Contact the healthcare provider 4. Administer PRN acetaminophen Home Medications Jeff is back at his healthcare provider’s office and his complaining of worsening constipation. In looking at Jeff’s home medication list, what does the nurse attribute to Jeff’s constipation? Select all that apply. 325 mg Acetaminophen PO PRN Artificial tears PRN dry eyes Calcium carbonate PRN 1-3 hours after meals and at bedtime Oxycodone hydrochloride ER tablets 10 mg PO every 12 hours PRN post-operative pain 40 mg omeprazole PO daily Screening The nurse is at a community event screening clients for their risks of developing gastroesophageal reflux disease (GERD). Which of the following clients is at risk of developing GERD? Select all that apply. Inflammatory Bowel Disease Prepare: Inflammatory Bowel Disease Crohn’s Disease Location What portion of the intestinal tract can be affected with Crohn’s Disease? Only the colon Anywhere along the GI tract Only the rectum Only stomach Autoimmune Disease Characteristics What is a classic characteristic of autoimmune diseases? They impact only the African American population They only impact the gastrointestinal system They are not genetically linked They have periods of exacerbation and remission Goals of Treatment What are the goals of treatment with inflammatory bowel disease (IBD)? Select all that apply. Help the client achieve and maintain remission of symptoms Improve nutritional status deficits Because of their symptom’s chronic nature, only treat when they are severe Educate the client on how to alleviate stress Treat the client with the most cost-effective way to manage their disease Self-Check: Crohn’s Disease Complication Knowing the pathophysiology of inflammation for Crohn’s disease, the client with this disease is at risk for developing which of the following complications? Peritonitis Cirrhosis Toxic megacolon Portal hypertension Self-Check: Ulcerative Colitis Complication The nurse knows that rectal bleeding is a common finding in ulcerative colitis. Which of the following questions is important for the nurse to ask James upon assessment? “Do you hear ringing in your ears?” “Do you feel weak or light-headed?” “Do you have a headache?” “Do you have a sensitivity to bright lights?” Self-Check: Priority Concerns Based on your previous clients’ charts, which of the following statements are the priority concerns for Bonnie and James? Choose the correct answer from the drop down boxes. Self-Check: Ulcerative Colitis Amy is a 28-year-old busy graduate student with ulcerative colitis (UC). Her father is James, one of your previous clients. Which of the following risk factors are associated with UC? Select all that apply. Stress Red hair Family history of ulcerative colitis Caucasian Self-Check: Therapeutic Response James has made a follow-up appointment with his healthcare provider about his cancer diagnosis. They have decided to proceed with a total colectomy with creation of a temporary ileostomy due to his severe ulcerative colitis. James and his wife seem visibly anxious about the lifestyle changes and care that his new ileostomy will bring to their lives. What is the most therapeutic response by the nurse? “Your ileostomy is only temporary, so it’s nothing to worry about.” “Lots of people have ileostomies and still lead normal lives.” “I will call the WOCN (wound ostomy care nurse) and she will talk to you about it.” “Tell me what your concerns are regarding your surgery and ileostomy.” Reflect: Inflammatory Bowel Disease Expected Prescriptions J.T, a 34-year-old male arrives to the emergency department with an exacerbation of ulcerative colitis. He is complaining of stabbing abdominal pain that is 9 out of 10 on the 0-10 pain scale, with worsening bloody diarrhea. Which of the following prescriptions do you anticipate that the healthcare provider will order? Select all that apply. Obtained informed consent for a total colectomy Put the client on NPO status Place a rectal tube Place a nasogastric tube Initiate cardiac monitoring Ileostomy Diet James is worried about dealing with the odor associated with his temporary ileostomy. Which of the following food items would you instruct James to keep out of his diet as they are gas forming, odor producing, or can cause diarrhea? Select all that apply. Eggs Broccoli Carbonated beverages Beer Potatoes Bread Routes of Administration Understanding the routes of administration for biologic/targeted therapy for inflammatory bowel disease (IBD), which of the following clients would be appropriate for subcutaneous injections? Select all that apply. A 78-year-old female with severe rheumatoid arthritis (RA) of the hands who lives alone A 26-year-old male who is in nursing school A 34-year-old female with dermatitis A 64-year-old male with diabetes mellitus type II Immediate Interventions Which of the following clients with ostomies require immediate intervention? Stomal tissue moderately edematous. Stomal tissue oozing small amount of blood. Stomal tissue appears dusk/pale and is cool to the touch. Stomal tissue appears beefy red in color. Medication Adherence Bonnie has come back to the clinic to discuss methods to assist her in being more compliant with her medications. Which of the following methods do you recommend? Select all that apply. Purchase a daily pill box Set an alert or reminder on her phone Take her medications at the same time everyday Involve her family and friends Combine taking her medications with a daily task, such as brushing your teeth Ostomy Care Reorder the steps of ostomy care from start to finish. Drag and drop the items into the correct order. 1. Wash hands 2. Remove the old skin barrier/wafer, and dispose of it 3. Clean the skin surrounding the stoma with a clean, moist gauze 4. Size the skin barrier/wafer to the stoma 5. Adhere the skin barrier/wafer to the skin 6. Attach the collection pouch to the skin barrier/wafer Priority Nursing Diagnosis The nurse has entered the room of a client with a newly created ileostomy. They observe the client tearful sitting in bed. When the nurse approaches the client to change her ostomy dressing, the client becomes upset, stating, “Don’t touch that! It’s so awful to look at and it smells terribly. I’m never leaving my house again”. What is priority nursing diagnosis for this client? Deficient knowledge Disturbed body image Risk for imbalanced nutrition Risk for impaired skin integrity Client Education J.T. was started on methotrexate and adalimumab for his ulcerative colitis, and is about to be discharged home. What client education would you provide J.T. about his new medication regimen? Select all that apply. “You will only need to take these medications if your symptoms become worse.” “You must store your adalimumab (Humira) in the refrigerator.” ”You may experience flu-like symptoms when starting your methotrexate.” “You will need to come to the hospital or an infusion center to receive your adalimumab treatment.” “The methotrexate will help treat any present infections.” [Show More]

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