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- The nurse is caring for a patient with a BMI of 32. The nurse best explains to the patient their results by saying:
- You are considered a healthy weight
- You are considered overweight
- You are considered obese
- You are considered morbidly obese
- A patient has a waist-to-hip ratio of 1.2 and asks a nurse what that means. The nurse best explains by saying:
- You are smaller than average and should increase your intake of carbohydrates
- This is a healthy waist-to-hip ratio
- Your waist-to-hip ratio indicates that you are at greater risk for health complications
- This indicates that you have gynoid obesity
- When admitting a patient gastric bypass procedre, what would NOT be an appropriate instruction for the nurse to give a trained UAP?
- Be especially careful to turn or reposition this patient slowly
- Teach the patient to use the incentive spirometer
- Make sure the head of the bed is elevated to at least 35 degrees
- Apply SCDs to the patient’s legs
- The patient demonstrates a need for further education post-op following gastric bypass surgery when she says:
- I should eat six small meals per day and drink fluids between instead of with my meals
- I should decrease the amount of roughage I eat
- I may experience plateaus in my weight loss
- I hope to have a baby in the next 12 months.
- When planning a diet for a patient with gastritis, the nurse might suggest the patient:
- Limit snacking and stick to three meals per day
- Limit fluid intake to 1000mL per day
- Choose non-irritating food items and eliminate spicy foods
- Take ibuprofen (Motrin) for gastric pain
- When interviewing a patient with gastritis, the nurse would make sure to ask about:
- Use of NSAIDs
- Exercise regime
- Use of PPIs
- Concurrent headaches
- A nurse is admitting a patient with gastritis. He is a 65 year old Caucasian male who reports he has smoked a half pack per day for 30 years and denies alcohol use. He admits to a sedentary lifestyle and has an office job he says is “stressful.” The nurse recognizes his risk factors as (select all that apply):
- Sedentary Lifestyle
- The nurse is about to conduct a focused abdominal assessment. The best way for the nurse to procede is:
- Inspection, palpation, percussion, auscultation
- Inspection, auscultation, percussion, palpation
- Auscultation, percussion, palpation, inspection
- Palpation, percussion, auscultation, inspection
- The nurse observes a UAP preparing to exit the room of a patient with Clostridium difficile. The nurse would intervene if witnessing the UAP..
- Disposing of used PPE in the red biohazard bin
- Not touching the outside of her gown or gloves when removing them
- Not wearing a face mask
- Using an alcohol-based hand sanitizer before exiting the room
- The nurse is reviewing with the UAP how to provide peri-care to a patient with diarrhea. The nurse realizes the UAP requires further instruction when he reports:
- I should provide peri-care any time there is soiling from the diarrhea
- I should wipe the peri-area from front-to-back to prevent infection
- I should use a strong soap to make sure I get the area very clean
- A skin barrier cream can be applied to help prevent skin breakdown
- The nurse understands a need for further teaching when a patient newly diagnosed with GERD reports:
- I will miss being able to eat chocolate candy regularly
- I won’t drink a glass of milk at bedtime anymore
- I like to drink a big glass of water with my supper
- I’ll choose a turkey burger instead of a beef burger
- Which statement by the patient demonstrates understanding of the medication?
- My sucralfate (Carafate) should be taken about an hour before I eat and at bedtime
- I will take my pantoprazole (Protonix) at bedtime
- I may experience some constipation when I take my betanechol (Urecholine)
- I don’t need to worry about serious side effects with Metoclopramide (Reglan)
- What would NOT be an appropriate instruction for the nurse to give a patient with GERD?
- Elevate the head of your bed on blocks
- Avoid eating late-night snacks just before bed
- Take your PPI before the first meal of the day
- Lay down after your meal to enhance absorption
- A nurse notices an increased heart rate and copious amounts of red asipirate in a patient with PUD. The nurse’s priority intervention is to:
- Start IV fluid replacement
- Maintain patency of the NG tube
- Recheck VS and aspirate in 15 minutes
- Give the patient a unit of whole blood
- What would NOT be an appropriate intervention by the nurse in a patient following gastric sugery?
- Administering medications for pain as ordered
- Checking the NG tube for patency and repositioning as necessary
- Preparing for an order of IV potassium
- Encouraing early ambulation
- The nurse is planning interventions for a patient with colitis. Which interventions by the nurse would be appropriate (select all that apply)?
- Applying a barrier cream to the skin of the peri-area
- Using hot water and harsh soap to clean around the rectum
- Teaching the patient Kegel exercises
- Administering supplemental IV fluids and electrolytes as ordered
- Encouraging a high-calorie, low-fiber diet
- A Caucasian patient of Jewish decent admits to the nursing unit with Crohn’s disease. She is a vegetarian and reports that she takes ibuprophen (Motrin) frequently for headaches. She smokes a pack a day. The nurse recognizes this patient’s risk factors for Crohn’s as (select all that apply):
- Use of Motrin
- The nurse understands that which of the following is NOT part of managing an acute flare of Crohn’s disease?
- Administration of corticosteroids
- Meticulous skin care
- A high-fiber diet
- Providing a quiet environment
- Appropriate action by a nurse caring for a patient with a hiatal hernia would include:
- Administering a PPI before the patient eats breakfast
- Keeping the patient in a Trendleberg position
- Allowing the patient to rest supine after supper
- Giving the patient a spicy taco for lunch
- A patient is suspected of having peritonitis. With this knowledge, the nurse expects to find which of the following on inspection of the patient (select all that apply)?
- Rigid, board-like abdomen
- Presence of fluid wave
- Rebound tenderness
A BMI <18.5 is underweight, 18.5-24.9 is a normal bodyweight, 25-29.9 is overweight, 30+ is obese, and >40 is morbidly (severely) obese. Therefore, this patient is considered obese.
A waist-to-hip ratio >0.8 puts a patient at greater risk for health complications related to their obesity because it indicates they have mostly truncal fat.
Although these are all appropriate interventions post-operatively for a patient from baratric surgery, the nurse should not delegate patient education to the UAP. The UAP should reposition the patient carefully because anesthesia could be stored in adipose tissue and be released when the patient is turned. The head of the bed should remain elevated to reduce abdominal pressure and increase lun expansion. SCDs should be applied because the patient will be at an inreased risk for a DVT in the immediate post-op period when they are not ambulating. The nurse could delegate the UAP to make sure the patient is using the incentive spirometer once the patient has been taught how to use it by the nurse.
Many women experience a return to fertility following bariatric surgery. However, they should wait 12-18 months to get pregnant due to pregnancy complications associated with anemia and nutritional deficiencies that are common following this type of surgery.
A patient with gastritis may benefit from abstaining from spicy foods and choosing non-irritating food items. Patients may benefit from eating six smaller meals a day instead of three large meals. There is no need to limit fluid intake. NSAIDs such as Motrin often contribute to irritation of gastric mucosa and would not be appropriate.
NSAIDS commonly cause gastritis by inhibiting prostoglandin synthesis, thereby eliminating prostoglandins’ protective properties to gastric mucosa, making the mucosa more susceptible to injury. Exercise, and concurrent headaches are not associated with gastritis. Although GERD is treated with PPIs and GERD is a risk factor for gastritis, PPIs themselves are not associated with gastritis.
- A, B, D, F
Gastritis is most common in women, those >60 years, and Caucasians. Other risk factors include smoking, alcohol use, and stress. Exercise regime does not affect gastritis.
Inspection is always the first step in assessing the body. Although normally the order is inspection, palpation, percussion, auscultation, in the abdomen it is inspection, auscultation, percussion, palpation. This way, palpating the abdomen does not create disturbances to the presence and nature of the patient’s bowel sounds.
The only way to prevent the spread of C. diff spores is to wash with soap and warm water for at least 15 seconds according to proper hand-washing technique. Alcohol-based hand rubs will not remove the C. diff spores. C. diff requires enteric contact precautions, so a face mask is not necessary unless the UAP suspects splashing of body fluids. The other two options demonstrate proper technique of using PPE.
Plain water or water and a mild soap should be used. Harsh soaps should be avoided to prevent irritation to the skin. The other statements reflect good practice for peri-care in a patient with diarrhea.
The patient should be encouraged to drink fluids in between meals instead of with meals. Limiting intake of chocolate/caffeine, avoiding late-night snacking and milk at bedtime, and choosing low-fat options (such as turkey instead of beef) are appropriate interventions for a patient with GERD.
Sucralfate coats the lining of the stomach and has cytoprotective properties. To work best, it should be taken about an hour before meals and at bedtime. Pantoprazole should be taken before the first meal of the day. Bethanechol is a cholinergic medication and may cause diarrhea, not constipation. Metoclopramide can cause CNS effects such as anxiety, hallucinations, and extrapyrimidal effects.
The patient should not lay supine for 2-3 hours after a meal. The patient should elevate the head of their bed 30 degrees with pillows or blocks. They should avoid reflux-inducing activities/foods such as late-night snacking. PPIs should be taken before the first meal of the day.
The patient is likely experiencing a hemorrhage. The nurse’s priority is to maintain patency of the NG tube and ensure it does not become blocked with blood clots, which could cause abdominal distention. Although administering IV fluids or blood may be ordered, they is not the first intervention, and the nurse should not perform these task without an order. Hemorrhage requires immediate intervention, and the nurse should not wait 15 minutes to recheck vitals and aspirate.
The nurse should not reposition the NG tube. The nurse should check for patency and contact the surgeon if it may not be patent or may be positioned incorrectly. It is appropriate to encourage early ambulation and administer pain medications as ordered. The physician may order IV potassium and/or vitamins until oral feedings are resumed.
- A, C, D, E
It is appropriate to use a barrier cream to protect the skin of the peri-area in a patient with diarrhea. Kegel exercises may help the patient to maintain continence of bowel. The patient may receive IV fluids and electrolytes to replace fluid/electrolyte loss through the bowel. A high-calorie diet helps to meet the patient’s nutritional needs, while a low-fiber diet helps prevent diarrhea. Plain warm water or warm water with a mild soap should be used to clean the peri-area to avoid irritating the skin.
- A, C, D
Caucasians, especially those of Jewish decent, are at a higher risk for developing Crohn’s disease. Use of NSAIDs such as Motrin and smoking increase the risk of Crohn’s. A diet high in fat and meat contributes to a risk for Crohn’s. There is no known link between alcohol and Crohn’s.
High fiber foods can contribute to diarrhea and may exacerbate an acute flare-up of Crohn’s. Generally, patients receive a high-calorie, low-fiber, lactose-free diet. Corticosteroids, skin care, and measure to decrease stress are all appropriate in treating an acute flare of Crohn’s.
PPIs should be taken before the first meal of the day. Patients should not lay supine for 2-3 hours after a meal, and the head of the bed should be elevated 30 degrees with pillows or blocks. Spicy or otherwise irritating foods/activities should be avoided.
- B, C, D
Patients with peritonitis develop a rigid, board-like abdomen, rebound tenderness, presence of a fluid wave, and hyperthermia.