The nurse is caring for a patient with the diagnosis of sepsis. The patient is on a ventilator in the critical care unit, and is receiving a proton pump inhibitor (PPI) to reduce the risk for a stress ulcer. In this scenario, a stress ulcer is likely to be secondary to
decreased acetylcholine production
infection with Helicobacter pylori bacteria.
ischemia associated with sepsis.
a decreased number of parietal cells.
A patient has been admitted to the critical care unit after a stroke. After “failing” a swallow study, the patient is placed on enteral feedings. Following placement of a nasogastric tube for tube feeding, what is the next critical step?
Obtain a chest radiograph.
Start the tube feeding.
Cap off and wait 24 hours before starting feedings.
Administer medications.
Approximately 5 days after starting tube feedings, a patient develops extreme diarrhea. A stool specimen is collected to check for which possible cause?
Clostridium difficile
Occult blood
Escherichia coli
Ova and parasites
Pain control is a nursing priority in patients with acute pancreatitis because pain
is caused by dilation of the biliary system.
decreases the patient’s metabolism.
increases pancreatic secretions.
is caused by decreased distension of the pancreatic capsule.
The liver plays a major role in homeostasis by
removing active clotting factors from the circulation.
synthesizing factor II but not factor I.
synthesizing clotting factors without the need for vitamin K.
synthesizing factor I but not factor II.
A patient, who has a tube feeding, requires a chest x-ray study for evaluation of a cough. To reduce the risk of aspiration, the nurse:
helps the radiology technician to position the patient to avoid dislodging the tube.
cuts the infusion rate by half.
stops feedings 10 to 15 minutes before placing flat to obtain the radiograph
slows the rate of the feedings until placement has been verified.
Infection by Helicobacter pylori bacteria is a major cause of
Curling’s ulcers.
duodenal ulcers.
stress ulcers.
Cushing’s ulcers
Malnutrition contributes to infection risk by
hampering normal gastrointestinal motility.
impairing immune function.
increasing drug interactions.
increasing blood glucose.
The nurse is caring for a patient with acute pancreatitis. To provide adequate pain control, the nurse
provides oral pain medication on an “as needed” (PRN) basis.
administers pain medication on a routine schedule.
should suggest that the patient receive epidural analgesia.
removes any nasogastric tubes.
A patient with acute pancreatitis is started on parenteral nutrition. The student nurse listed possible interventions for this patient. Which intervention needs correction before finalizing the plan of care?
Infuse antibiotics through the intravenous line.
Monitor the blood glucose every 6 hours.
Change the intravenous tubing every 24 hours.
Monitor the fluid and electrolyte balance.
The patient is admitted with generalized fatigue and low hemoglobin and hematocrit levels. The patient denies vomiting and states that the last bowel movement earlier that day was normal in color and consistency. However, because GI blood loss can be a cause of anemia, the nurse should expect to
inspect the patient’s next stool for the presence of coffee-ground contents.
obtain a stool sample for guaiac testing.
chart that the patient reports the presence of melena in his stool.
obtain guaiac positive stools only if bleeding is current.
The patient is admitted with severe abdominal pain due to pancreatitis. The patient asks the nurse, “What causes this? Why does it hurt so much?” The nurse should answer:
“Pancreatitis is caused by diabetes; you should be checked.”
“Pancreatitis is extremely rare, and no one knows why it causes pain.”
“Injury to certain cells in the pancreas causes it to digest (eat) itself, causing pain.”
“The pain is localized to the pancreas. Fortunately, it will not affect anything else.”
Metronidazole is being given to treat hepatic encephalopathy. When administering this medication, the nurse
evaluates renal function daily.
watches the patient for diarrhea.
assesses the patient for epigastric discomfort.
instructs the patient that this medication must be taken for 2 weeks.
In addition to residual stomach volume, what other evidence suggests feeding intolerance?
Abdominal distension
Elevated blood glucose by fingerstick
Active bowel sounds
Absence of tympany on percussion
A critically ill patient has a nonhealing wound and malnutrition. Which component of nutritional supplementation is most important for this patient to receive?
Vitamin A
Arginine
Branched-chain amino acids
Omega-3 fatty acids
A patient is being ventilated and has been started on enteral feedings with a nasogastric small-bore feeding tube. What is the primary reason the nurse must frequently assess tube placement?
To maintain the patency of the feeding tube
To prevent aspiration of the feedings
To monitor for skin breakdown on the nose
To assess for paralytic ileus
The nurse is assessing the patient and notices that the oral cavity is only slightly moist and contains a scant amount of thick saliva even though the patient’s fluid intake has been sufficient. The nurses realizes that the condition of the patient’s mouth is probably caused by
overstimulation of the sublingual glands.
parasympathetic nerve stimulation.
sympathetic nerve stimulation.
thoughts of food.
The patient is admitted for GI bleeding, but the source is unknown. Before ordering endoscopy, the provider orders octreotide to be given intravenously. The purpose of this medication is to
increase blood flow in the liver’s collateral circulation.
decrease splanchnic blood flow and portal pressure.
increase portal pressure and improve liver function.
vasodilate the splanchnic arteriolar bed.
When assessing the patient’s bowel sounds, the nurse
listens to bowel sounds before palpation
listens to the abdomen after palpation is done.
places a pillow over the patient’s knees.
places the patient in a relaxed prone position.
Patients experiencing severe physiological stress increase their nutritional requirements to:
35 kcal/kg/day.
50 kcal/kg/day
20 kcal/kg/day.
30 kcal/kg/day.
Select the physiological reasoning behind enteral therapy as the preferred source of nutritional therapy.
Gastroparesis increases
Bacterial translocation is initiated.
Gut mucosa is preserved.
Gut overgrowth increases.
The nurse is caring for a patient with active GI bleeding. Estimated blood loss is 1,000 mL. Which of the following assessments would the nurse expect to find with this amount of blood loss?
Heart rate 125 beats per minute.
All vital signs would expect to be normal.
Systolic blood pressure of 120 mm Hg.
Oral temperature of 103°.
In evaluating a patient’s nutrition, the nurse would monitor which blood test as the most sensitive indicator of protein synthesis and catabolism?
Prealbumin
BUN
Albumin
Triglycerides
A patient is being fed through a nasogastric tube placed in his stomach. The nurse would carry out which intervention to minimize aspiration risk?
Assess the residual every hour.
Elevate the head of the bed 30 degrees.
Provide feedings via continuous infusion.
Add blue dye to the formula.
The nurse is assessing a patient who is admitted with abdominal pain. To detect abdominal masses, the nurse
watches for signs of pain and distension.
looks for pulsations originating from the vena cava.
has the patient take a deep breath.
observes for skin pigmentation and discolorations.
