Pharmacotherapy
A patient has peptic ulcer disease associated with Helicobacter pylori. Which medications will the nurse plan to teach the patient?
A. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec)
B. Sucralfate (Carafate), nystatin, and bismuth (Pepto-Bismol)
C. Famotidine (Pepcid), magnesium hydroxide (Mylanta), and pantoprazole
D. Metoclopramide (Reglan), bethanechol, and promethazine
A. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec)
The drugs used in triple drug therapy include a proton pump inhibitor such as omeprazole and the antibiotics amoxicillin and clarithromycin. The other combinations listed are not included in the protocol for H. pylori infection.
Which information about dietary management would the nurse include when teaching a patient with peptic ulcer disease (PUD)?
A. “Avoid foods that cause pain after you eat them.”
B. “You should avoid eating raw fruits and vegetables.”
C. “High-protein foods are least likely to cause pain.”
D. “You will need to remain on a bland diet.”
A. “Avoid foods that cause pain after you eat them.”
The best information is that each person should choose foods that are not associated with postprandial discomfort. Raw fruits and vegetables may irritate the gastric mucosa but chewing well seems to decrease this problem and some patients tolerate these healthy foods well. High-protein foods help neutralize acid, but they also stimulate hydrochloric (HCl) acid secretion and may increase discomfort for some patients. Bland diets may be recommended during an acute exacerbation of PUD, but there is little evidence to support their ongoing use.
Which risk factor would the nurse specifically ask about when a patient is being admitted with acute pancreatitis?
A. Cigarette smoking
B. High-protein diet
C. Alcohol use
D. Diabetes
C. Alcohol use
Alcohol use is one of the most common risk factors for pancreatitis in the United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors.
Which patient statement would indicate to the nurse that teaching after a laparoscopic cholecystectomy was effective?
A. “I can expect yellowish drainage from the incision for a few days.”
B. “I can take a shower and walk around the house tomorrow.”
C. “I will follow a low-fat diet for life because I do not have a gallbladder.”
D. “I need to limit my activities and not return to work for 4 weeks.”
B. “I can take a shower and walk around the house tomorrow.”
After a laparoscopic cholecystectomy, patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a lifelong requirement.
A patient with a stroke is unconscious and unresponsive to stimuli. After learning that the patient has a history of gastroesophageal reflux disease (GERD), which assessment would the nurse plan to make more frequently than is routine?
A. Bowel sounds
B. Breath sounds
C. Apical pulse
D. Abdominal sounds
B. Breath sounds
Because GERD may cause aspiration, the unconscious patient is at risk for developing aspiration pneumonia. Bowel sounds, abdominal girth, and apical pulse will not be affected by the patient’s stroke or GERD and do not require more frequent monitoring than the routine.
Which information will the nurse include when teaching a patient with peptic ulcer disease about the effect of famotidine (Pepcid)?
A. “Famotidine covers the ulcer with a protective material.”
B. “Famotidine decreases gastric acid secretion.”
C. “Famotidine absorbs the excess gastric acid.”
D. “Famotidine constricts the blood vessels near the ulcer.”
B. “Famotidine decreases gastric acid secretion.”
Famotidine is a histamine-2 (H2) receptor blocker that decreases the secretion of gastric acid. Famotidine does not constrict the blood vessels, absorb the gastric acid, or cover the ulcer.
Which assessment would the nurse perform first for a patient who just vomited bright red blood?
A. Measuring the quantity of emesis
B. Palpating the abdomen for distention
C. Taking the blood pressure (BP) and pulse
D. Auscultating the chest for breath sounds
C. Taking the blood pressure (BP) and pulse
The nurse is concerned about blood loss and possible hypovolemic shock in a patient with acute gastrointestinal bleeding. BP and pulse are the best indicators of these complications. The other information is important to obtain, but BP and pulse rate are the best indicators for assessing intravascular volume.
When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient’s right hand. Which action would the nurse take next?
A. Check the calcium level in the health record.
B. Ask the patient about any arm pain.
C. Retake the patient’s blood pressure.
D. Notify the health care provider immediately.
A. Check the calcium level in the health record.
The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau’s sign. The health care provider would be notified after the nurse checks the patient’s calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.
Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis?
A. The patient has increased pain after eating.
B. The patient reports chronic heartburn.
C. The patient’s urine is bright yellow.
D. The patient’s stools are tan colored.
D. The patient’s stools are tan colored.
Tan or gray stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, and would be reported but do not require urgent intervention.
Which patient choice for a snack 3 hours before bedtime indicates that the nurse’s teaching about gastroesophageal reflux disease (GERD) has been effective?
A. Peanut butter and jelly sandwich
B. Glass of low-fat milk
C. Cherry gelatin with fruit
D. Chocolate pudding
C. Cherry gelatin with fruit
Gelatin and fruit are low fat and will not decrease lower esophageal sphincter (LES) pressure. Foods such as chocolate are avoided because they lower LES pressure. Milk products increase gastric acid secretion. High-fat foods such as peanut butter decrease both gastric emptying and LES pressure.
The health care provider prescribes antacids and sucralfate (Carafate) for treatment of a patient’s peptic ulcer. Which medication schedule would the nurse teach the patient?
A. Antacids 30 minutes before each dose of sucralfate is taken
B. Antacids after meals and sucralfate 30 minutes before meals
C. Sucralfate and antacids together 0 minutes before meals
D. Sucralfate at bedtime and antacids before each meal
B. Antacids after meals and sucralfate 30 minutes before meals
Sucralfate is most effective when the pH is low and should not be given with or soon after antacids. Antacids are most effective when taken after eating. Administration of sucralfate 30 minutes before eating and antacids just after eating will ensure that both drugs can be most effective. The other regimens will decrease the effectiveness of the medications.
Which of the following is a manifestation of a peptic ulcer?
A. Melena
B. Chest pain
C. Tan stool
D. Pain 5 hours after eating a meal
A. Melena
Peptic ulcers can cause bleeding in the gastrointestinal tract, leading to the presence of blood in the stool.
A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective?
A. Abdominal pain is decreased.
B. Grey Turner sign resolves.
C. Electrolyte levels are normal.
D. Bowel sounds are present.
A. Abdominal pain is decreased.
NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status has been effective. Electrolyte levels may be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this to occur to determine whether treatment was effective.
A patient had an incisional cholecystectomy 6 hours ago. Which action would the nurse identify as the highest priority for the patient to accomplish?
A. Ambulate the evening of the operative day.
B. Choose preferred low-fat foods from the menu.
C. Perform leg exercises hourly while awake.
D. Turn, cough, and deep breathe every 2 hours.
D. Turn, cough, and deep breathe every 2 hours.
Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions are also important to implement but are not as high a priority as ensuring adequate ventilation.
A patient who has gastroesophageal reflux disease (GERD) is experiencing increasing discomfort. Which patient statement to the nurse indicates a need for additional teaching about GERD?
A. “I take antacids between meals and at bedtime each night.”
B. “I sleep with the head of the bed elevated on 4-inch blocks.”
C. “I quit smoking years ago, but I chew gum.”
D. “I eat small meals and have a bedtime snack.”
D. “I eat small meals and have a bedtime snack.”
GERD is exacerbated by eating late at night, and the nurse would plan to teach the patient to avoid eating within 3 hours of bedtime. Smoking cessation, taking antacids, and elevating the head of the bed are appropriate actions to control symptoms of GERD.
An 80-yr-old patient who is hospitalized with peptic ulcer disease develops new-onset auditory hallucinations. Which prescribed medication will the nurse discuss with the health care provider before administration?
A. Omeprazole (Prilosec)
B. Metoclopramide (Reglan)
C. Aluminum hydroxide
D. Sucralfate (Carafate)
B. Metoclopramide (Reglan)
Metoclopramide can cause central nervous system side effects ranging from anxiety to hallucinations. Hallucinations are not a side effect of proton pump inhibitors, mucosal protectants, or antacids.
Which of the following is a preventive measure for peptic ulcers?
A. Skipping meals
B. Drinking alcohol 6 days a week
C. Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs)
D. Eating spicy foods regularly
C. Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs can increase the risk of peptic ulcers by irritating the lining of the stomach and small intestine.
Which assessment finding is of most concern for a patient with acute pancreatitis?
A. Palpable abdominal mass
B. Abdominal tenderness
C. Left upper quadrant pain
D. Absent bowel sounds
A. Palpable abdominal mass
A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.
A patient is currently experiencing acute cholecystitis. Where would the nurse expect the patient to complain of pain?
A. Right lower quadrant
B. Left lower quadrant
C. Right upper quadrant
D. Left upper quadrant
C. Right upper quadrant
What is the primary cause of GERD (gastroesophageal reflux disease)?
A. Excessive production of stomach acid
B. Weak or dysfunctional lower esophageal sphincter (LES)
C. Consuming spicy or acidic foods
D. Smoking and alcohol consumption
B. Weak or dysfunctional lower esophageal sphincter (LES)
GERD is primarily caused by a weak or dysfunctional lower esophageal sphincter (LES), which allows stomach acid to flow back into the esophagus.
How would the nurse explain esomeprazole (Nexium) to a patient who has recurring heartburn?
A. “It reduces gastroesophageal reflux by increasing the rate of gastric emptying.”
B. “It coats and protects the lining of the stomach and esophagus from gastric acid.”
C. “It neutralizes stomach acid and provides relief of symptoms in a few minutes.”
D. “It treats gastroesophageal reflux disease by decreasing stomach acid production.”
D. “It treats gastroesophageal reflux disease by decreasing stomach acid production.”
The proton pump inhibitors decrease the rate of gastric acid secretion. Promotility drugs such as metoclopramide (Reglan) increase the rate of gastric emptying. Cryoprotective medications such as sucralfate (Carafate) protect the stomach. Antacids neutralize stomach acid and work rapidly.
A nurse is providing discharge instructions to a client who has a peptic ulcer. Which of the following information should the nurse include in the teaching?
A. "Monitor for any increase or unintentional weight gain."
B. "Monitor for any changes in the color of your urine such as maroon or red-colored urine."
C. "Monitor for the appearance of ecchymosis on the sides of your abdomen/pelvic areas."
D. "Monitor for any changes in the color of your stool such as dark or black-colored stool."
D. "Monitor for any changes in the color of your stool such as dark or black-colored stool."
Which scheduling would the nurse teach a patient with chronic pancreatitis to use for the prescribed pancrelipase (Viokase)?
A. When feeling nauseated
B. Bedtime
C. When needed for pain
D. Mealtime
D. Mealtime
Pancreatic enzymes are used to help with digestion of nutrients and would be taken with every meal.
Which of the following client education topics should be included for a client with cholecystitis?
A. Dietary modifications to reduce fat intake
B. Exercises to strengthen the gallbladder
C. Methods for preventing gallstone formation
D. Indications for administering pancrelipase supplements at mealtimes
A. Dietary modifications to reduce fat intake
Clients with cholecystitis may benefit from reducing their fat intake as fatty foods can trigger symptoms.
A nurse is caring for a client who continues to have issues with GERD (gastroesophageal reflux disease). Which of the following statements provides the best preventative health care education for this client?
A. "A glass of wine per day might help with reducing your stress and improve your GERD."
B. "You can lay down 30 minutes after eating if that will help you feel better."
C. "Adding more citrus foods in your diet might help with easing the manifestations."
D. "It is important for you to practice good oral hygiene with this disorder."
D. "It is important for you to practice good oral hygiene with this disorder."
Due to acid reflux, good oral hygiene practices are important with GERD as the acid can damage the enamel of the teeth.