Inflammation/Elimination Study NUR3

Question 1

This condition is caused by H. Pylori bacteria and causes: midepigastric pain relieved by food if there is a duodenal ulcer or worsened by food if there is a gastric or stress ulcer, anorexia, and bloating

Answer 1

Peptic Ulcer Disease

Question 2

This test is the most accurate for diagnosing PUD and the patient is required to remain NPO until gag reflex has returned

Answer 2

EGD

Question 3

Treatment for this condition is: possible NG tube to rest GI and determine presence of blood in stomach; pain management with H2 blockers, Bismuth, PPIs, and antibiotics; triple therapy (PPi + 2 antibiotics) or quad therapy (PPI + 2 antibiotics + Bismuth)

Answer 3

Peptic Ulcer Disease

Question 4

What are the diet recommendations for someone with PUD?

Answer 4

Bland diet; avoid irritating foods, alcohol, caffeine; eat 6 small meals a day

Question 5

Patient teaching for Bismuth therapy

Answer 5

Do not take Aspirin with this medicine. It may cause black tongue and stools, but it is temporary and harmless.

Question 6

True or false: It is okay to abruptly stop taking a PPI if you do not notice any changes

Answer 6

False

Question 7

Patient with peptic ulcer disease reports having hematamesis, melana, and dizziness. Their heart rate is 135, BP is 110/60, Hgb/Hct is decreased. What do you suspect?

Answer 7

Hemorrhage

Question 8

Patient presents with a rigid, board-like abdomen. What do you suspect?

Answer 8

Peritonitis

Question 9

Patient presents with pain in the RLQ (Mcburney’s point), N/V, low grade fever, anorexia, and rebound tenderness of the abdomen. What do you suspect?

Answer 9

Appendicitis

Question 10

What are the priority nursing interventions for appendicitis?

Answer 10

NPO; prophylactic antibiotics to prepare for surgery, IV fluids, Pain management

Question 11

True or false: You can apply heat to the abdomen to relieve pain for someone with appendicitis

Answer 11

False. No heat can be applied and no enemas or laxatives can be administered due to risk of rupture.

Question 12

What are the complications of appendicitis?

Answer 12

Peritonitis, Perforation, Gangrene, Sepsis

Question 13

Patient presents with a rigid, board-like abdomen. What is your priority interventions?

Answer 13

Place in Fowler’s or semi-fowler’s position to promote drainage of peritoneal fluid. Monitor respiratory status and administer O2. Keep NPO. Administer hypertonic IV fluids and broad-spectrum antibiotics.

Question 14

Patient had an appendectomy yesterday. They report abdominal and shoulder pain. Is this to be expected?

Answer 14

Yes. The abdomen in inflated during an appendectomy which can cause gas pains after the procedure. The gas pains can radiate to the shoulder from the abdomen.

Question 15

Patient presents with a random onset of sever LUQ pain while lying down and resorts to fetal position to relieve pain. They state they have been feeling nauseous and their stool has also been looking white and floating in the toilet. You notice their eyes appear yellow and their stomach appears distended. Their glucose, ALT, bilirubin, and amylase are elevated. What do you suspect?

Answer 15

Chronic pancreatitis flare up

Question 16

Patient with pancreatitis reports “bruising” around the umbilicus. What is this?

Answer 16

Cullen’s sign

Question 17

Patient with pancreatitis reports “bruising” around their flank area. What is this?

Answer 17

Grey Turner’s Sign

Question 18

What are the nursing interventions for someone with pancreatitis?

Answer 18

Pain management(opioids, NPO, and fetal position); NG tube to promote nutrition and rest GI; IV fluids; promote frequent rest periods; PPIs to decrease gastric acid

Question 19

The cause of a patient’s pancreatitis is gallstones. What procedure(s) would you anticipate?

Answer 19

ERCP or lapcholey

Question 20

What is the most accurate test to confirm pancreatitis?

Answer 20

Contrast-enhanced CT

Question 21

For pancreatic enzyme replacement therapy (PERT), how and when should a patient take this medicine?

Answer 21

Take with every meal and snack. Do not chew or crush. Can be sprinkled on no-protein food

Question 22

Client education for pancreatic enzyme replacement therapy (PERT) to monitor the effectiveness of the therapy

Answer 22

Record number and consistency of stools. There should be a decrease of fatty stools

Question 23

Diet recommendations for someone with pancreatitis

Answer 23

Avoid alcohol, caffeine, and GI stimulants. Eat small frequent meals. High carb, high protein, low fat, bland diet.

Question 24

Patient presents with ascites. What procedure do you anticipate?

Answer 24

Paracentesis to remove the extra fluid. It is done at bedside. Patient should empty bladder prior to the procedure and prior to being weighed before the procedure. Weigh patient before and after procedure.

Question 25

Where would the pain be felt for someone with hepatitis if they were experiencing pain?

Answer 25

RUQ

Question 26

What are the hepatitis virus types that can be spread via fecal-oral?

Answer 26

HAV and HEV

Question 27

What are the hepatitis virus types that can be spread via blood/body fluids?

Answer 27

HBV, HCV, HDV

Question 28

What hepatitis virus types do have a vaccine?

Answer 28

HAV, HBV

Question 29

If a patient received the hepatitis B vaccine, what other hepatitis virus are they protected from and why?

Answer 29

Hepatitis D because to have hepatitis D, you also have to have Hepatitis B

Question 30

What is the most common chronic form of hepatitis virus?

Answer 30

HCV

Question 31

How long does a patient have to have hepatitis before being diagnosed with chronic hepatitis?

Answer 31

Longer than 6 months

Question 32

What procedure is done to confirm the diagnosis and stage of progression for hepatitis virus?

Answer 32

Liver Biopsy

Question 33

What is a patient most at risk for after a liver biopsy?

Answer 33

Hemorrhage/bleeding

Question 34

True or False: ALL hepatitis virus diagnoses must be reported to the health department

Answer 34

True

Question 35

How do you evaluate the effectiveness of antivirals for a patient with HBV?

Answer 35

Routine blood tests

Question 36

A patient has been exposed to HAV. How long do they have to receive the immunoglobulin?

Answer 36

10-14 days

Question 37

What is a priority intervention for someone diagnosed with hepatitis?

Answer 37

Symptomatic care and promote rest

Question 38

Diet recommendations for someone with Hepatitis

Answer 38

High-carb, high-calorie, moderate fat and protein diet. Small frequent meals.

Question 39

What should a patient with hepatitis avoid?

Answer 39

Poor hygiene, alcohol, OTC meds, and herbs

Question 40

This condition is caused by permanent scarring of the liver that results in the liver shrinking and hardening causing it not to function properly

Answer 40

Cirrhosis

Question 41

What vitamins does the liver absorb?

Answer 41

Fat soluble vitamins (A,D,E,K)

Question 42

If a patient with cirrhosis is not absorbing vitamin K, what are they most at risk of?

Answer 42

Bleeding

Question 43

Patient presents with jaundice, fatigue, RUQ pain, and pruritis. What do you suspect?

Answer 43

Cirrhosis

Question 44

What can you expect to see for ALT, AST, PT/INR, and bilirubin lab values in a patient with cirrhosis?

Answer 44

ALT, AST, Bilirubin elevated. PT/INR decreased.

Question 45

Patient with cirrhosis starts showing signs of AMS(confusion). What interventions will you do and anticipate?

Answer 45

Check ammonia levels for increase ( hepatic encephalopathy) and administer lactulose for treatment

Question 46

What patient education should you include when giving someone lactulose?

Answer 46

It will cause diarrhea but that is the reason for giving it so that the extra ammonia will be excreted

Question 47

How would you manage fluid volume in a patient with cirrhosis?

Answer 47

Diuretics and a low sodium diet

Question 48

How would you manage pruritis in someone with cirrhosis?

Answer 48

Corticosterioid cream, avoid getting too warm, apply cool compresses

Question 49

What should a patient with cirrhosis avoid

Answer 49

Alcohol, NSAIDS, OTC meds

Question 50

Diet recommendations for someone with cirrhosis

Answer 50

High-cal, low-sodium-moderate fat diet

Question 51

Patient presents with RUQ pain that radiates to the right shoulder after eating a high fatty meal. They also state they have a burning in the chest indicative of indigestion (dyspepsia). Upon abd assessment, you note they have rebound tenderness. What do you suspect?

Answer 51

Gallbladder disease

Question 52

A patient with gallbladder disease is unable to have surgery as a treatment option. What treatment do you anticipate?

Answer 52

Gallstone stabilizing agents

Question 53

A patient with gallbladder disease underwent a lapcholey, but reports feeling hungry after. What should you do next?

Answer 53

Determine if gag reflex has returned because they have to remain NPO until gag reflex returns and educate them about introducing one fatty food at a time

Question 54

Diet recommendations for someone with gallbladder disease

Answer 54

High fiber, low fat diet. Eat small frequent meals. Avoid high-fat/high-cholesterol foods.

Question 55

What procedure can be done to diagnose and also remove gallstones?

Answer 55

ERCP

Question 56

Patient reports severe flank pain and sitting still makes the pain worse, dysuria, and hematuria. You notice that they are diaphoretic and appear pale. What do you suspect?

Answer 56

Kidney stones

Question 57

What is the priority intervention for a patient with kidney stones?

Answer 57

Pain management (IV opioids can be used in combination with NSAIDs)

Question 58

Why should a patient who is passing a kidney stone strain all urine?

Answer 58

To catch the stone or fragments of the stone so that it can be tested to see what is the cause of the kidney stones

Question 59

How much should a patient with kidney stones be advised to drink daily?

Answer 59

3L/day

Question 60

True or False: A patient with kidney stones can take a hot bath or apply moist heat to ease pain and promote comfort

Answer 60

True

Question 61

What medicine is given for increased uric acid levels in someone with kidney stones?

Answer 61

Allipurinol

Question 62

What procedure can be done to break up stones for someone with kidney stones?

Answer 62

Lithotripsy

Question 63

What should be done preoperatively for someone undergoing a lithotripsy?

Answer 63

Should be placed in supine position and a topical anesthetic should be applied over the area of the stone 45 minutes prior to the procedure

Question 64

What should be monitored closely in someone who is taking an antispasmolytic medication?

Answer 64

I&O for hydration status because antispasmolytic medications have anticholinergic effects

Question 65

Ketoralac medication increases the risk of what complication?

Answer 65

Bleeding

Question 66

What post-op education should be given to a patient undergoing a lithotripsy?

Answer 66

Bruising for up to 1 week and temporary hematuria are expected

Question 67

What education should be given to someone taking Gentamicin or Cephalexin?

Answer 67

Take with food. Take the full course of medication. These can cause urine to have a foul odor.

Question 68

When is an IVP contraindicated to diagnose kidney stones?

Answer 68

If there is a urinary obstruction, allergy to shellfish or iodine, or if they are taking metformin

Question 69

When taking oxybutynin, what problems should the patient report to the HCP?

Answer 69

Palpitations, problems with voiding, or constipation

Question 70

What should be monitored in patients taking gentamicin?

Answer 70

Nephrotoxicity and ototoxicity

Question 71

Diet recommendations for a patient who had kidney stones due to calcium phosphate build up

Answer 71

Limit intake of food high in animal protein. Limit sodium intake. Reduce calcium intake (dairy products)

Question 72

Diet recommendations for a patient who had kidney stones due to calcium oxolate build up

Answer 72

Avoid spinach, black tea, rhubarb, cocoa, beets, pecans, stawberries, peanuts, okra, and chocolate. Limit sodium intake.

Question 73

Diet recommendations for a patient who had kidney stones due to magnesium ammonium phosphate build up

Answer 73

Avoid dairy products, red and organ meats, and whole grains

Question 74

Diet recommendations for a patient who had kidney stones due to uric acid build up

Answer 74

Avoid organ meats, poultry. fish, gravies, red wine, sardines.

Question 75

Diet recommendations for a patient who had kidney stones due to cystine build up

Answer 75

Limit animal protein intake

Question 76

This condition injures and inflames the glomerulus. It can be acute or chronic. Acute infection comes from strep infection. Chronic infection comes from another disease/infection. It can occur at any age.

Answer 76

Glomerulonephritis

Question 77

Patient presents with periorbital edema, fatigue, and painful urination. Patient recently had strep and has a low grade fever. What do you suspect?

Answer 77

Glomerulonephritis

Question 78

Why would a patient with glomerulonephritis have respiratory fluid overload symptoms?

Answer 78

Urinary retention due to the inflammation of the glomerulus can cause fluid overload, which can then cause fluid overload in the respiratory tract

Question 79

What would the lab levels look like in someone with glomerulonephritis? UA, GFR, BUN/Creatinine,K+

Answer 79

Urinalysis may show hematuria and proteinuria. The glomerular filtration rate may be decreased. BUN/Creatinine may be increased. Potassium may be increased.

Question 80

What is the priority assessment for someone with glomerulonephritis?

Answer 80

FVO

Question 81

What are the priority interventions for someone with glomerulonephritis?

Answer 81

Daily weights, fluid restriction, low sodium and low potassium diet, diuretics, antihypertensives

Question 82

This 60 year old man presents with urinary frequency with a weak stream. Reports that he can not sleep because of getting up at night so often to void. Patient is obese. Reports that he used to drink coffee everyday but stopped a week ago to try to help him sleep better. What do you suspect?

Answer 82

Benign Prostatic Hyperplasia

Question 83

What procedure would you anticipate for a patient with BPH that has tried other noninvasive treatments with no success?

Answer 83

TURP

Question 84

Post-TURP teaching for patient

Answer 84

Avoid heavy lifting, drink 12 or more 8 ounce glasses of water a day unless CI, avoid NSAIDS,. If urine appears bloody, stop activity, rest, and increase fluids. Avoid meds that cause decreased bladder tone. Once cleared, frequent ejaculation helps decrease the size of the prostate.

Question 85

A patient has a 3 way catheter after having a TURP procedure. The urine in the catheter is bright red with large blood clots. What should you do?

Answer 85

Increase CBI rate

Question 86

A patient with a 3 way catheter is complaining of abdomen pain and urine output is decreased. What does this indicate and what should you do?

Answer 86

Obstruction; Turn off the CBI and irrigate with 50 mL irrigation solution. Contact the surgeon if unable to dislodge the clot.

Question 87

True or false: A patient with a 3 way catheter will feel a continuous need to void.

Answer 87

True

Question 88

Your patient with BPH reports difficulty urinating. What medication would you anticipate administering and how should it be taken?

Answer 88

Alpha 1-adrenergic antagonists (Tamulosin aka Flomax). Take with a full glass of water.

Question 89

What education should you give a patient on 5-ARI (Finasteride)?

Answer 89

May take 6 months before medicine effects are evident. Impotence and low libido are possible adverse effects. Teratogenic to a male fetus.

Question 90

The HCP wants to prescribe a medicine to reduce the size of the prostate in a patient. What medicine do you anticipate?

Answer 90

5-ARIs (Finasteride)

Question 91

Education for a client with BPH

Answer 91

Avoid drinking large amounts of fluid in a short time. Avoid drinking fluids before going out or at bedtime. Limit caffeine and alcohol due to diuretic effect. Avoid drugs that can cause urinary retention (anticholinergics, antihistamines, antipsychotics, muscle relaxants)

Question 92

This condition causes chronic inflammation of the rectum and rectosigmoid colon but can extend to the entire colon when the disease is extensive.

Answer 92

Ulcerative Colitis

Question 93

Your patient reports having 10-20 bloody stools a day and pain in the LLQ, and loss of appetite. What do you suspect?

Answer 93

Ulcerative Colitis

Question 94

Your patient is set to have a barium enema. What should you monitor for during this procedure?

Answer 94

Signs and symptoms of bowel perforations (rectal bleeding, firm abdomen, tachycardia, hypotension)

Question 95

Findings from the barium enema shows ulcerations and narrowing of the small intestine. What does this indicate?

Answer 95

Crohn's Disease

Question 96

Findings from the barium enema shows ulcerations and inflammation of the sigmoid colon and rectum. What does this indicate?

Answer 96

Ulcerative Colitis

Question 97

What diet recommendations should be given to patients with UC or CD?

Answer 97

High-protein, high-calorie, low-fiber diet. Avoid caffeine and alcohol. Small, frequent meals

Question 98

Why would you put a patient NPO and on TPN if they have ulcerative colitis?

Answer 98

For extreme or long exacerbations, to promote bowel rest while providing adequate nutrition

Question 99

Education for a patient with UC or CD

Answer 99

Take a MVI with iron, weigh 1-2 times a week

Question 100

Aminosalicylates are given for UC and CD to reduce inflammation but are CI in patients who are allergic to sulfa. What education should you give the patient?

Answer 100

Take with folic acid. It can cause urine, skin, and contact lenses to have a yellow-orange color. Avoid sun exposure. Take with a full glass of water. Increase fluid intake to 2L/day.

Question 101

Corticosteroids are given for inflammation and pain in UC and CD. What lab values should you monitor closely?

Answer 101

Increased sodium, decreased potassium, increased glucose, decreased calcium.. indicates Cushings Syndrome

Question 102

Corticosteroids are given for inflammation and pain in UC and CD. What education should you give the patient?

Answer 102

Take with food. Avoid crowds and other exposures to infections.

Question 103

Antidiarrheals are given to aid in control of bowel movements in UC and CD. What should you monitor for?

Answer 103

Hypotension, fever, abdominal distension, decrease or absence of bowel sounds.. indicates toxic megacolon

Question 104

What are immunomodulators used for in UC?

Answer 104

To suppress the immune response because UC is an autoimmune disorder

Question 105

A patient may have to have an ostomy as treatment for UC or CD. When should you empty the pouch and when should it be changed?

Answer 105

The pouch should be emptied when it is 1/3 to 1/2 full. Change the pouch every 3-7 days and wash the skin around it with warm water.

Question 106

What should the stoma of an ostomy look like? and when should you report the condition of it to the HCP?

Answer 106

The stoma should be red or pink and beefy. Report to the HCP if the stoma is pale, dusky, purple, black, does not bleed when gently washed, shows rash and/or blisters.

Question 107

What should be considered when fitting an ostomy for a patient?

Answer 107

Location, size, amount of drainage, contour of the abdomen, condition of the skin around the stoma, activities of the patient, patient's personal preferences, age and dexterity, and cost of the equipment

Question 108

Patient reports having 5-6 bloody stools a day, stool that appears white(steatorrhea), weight loss, and pain in the RLQ. What do you suspect?

Answer 108

Crohn's Disease

Question 109

This condition is a chronic inflammatory disease of the small intestine, the colon, or both but can involve the entire GI tract.

Answer 109

Crohn's Disease

Question 110

An Xray of the GI tract shows a cobblestone appearance. What does this indicate?

Answer 110

Crohn's Disease

Question 111

Immnosuppressants are given to clients with Crohn's Disease. What should you monitor for?

Answer 111

Pancreatitis and neutropenia

Question 112

Immunosuppressants are given to clients with Crohn's Disease. What should you tell the patient that is taking this?

Answer 112

It can take up to 6 months to see therapeutic effects

Question 113

If an abscess and fistula form from Crohn's Disease, what are the nursing interventions?

Answer 113

Monitor F&E and for dehydration. Provide high protein and high calorie (at least 3000 calories/day), low fiber diet. Administer a vitamin supplement. Monitor for infection.

Question 114

Your patient on antidiarrheals develops toxic megacolon and is now at risk for perforation. What are your nursing interventions?

Answer 114

Maintain nasogastric suction, administer IV fluids and electrolytes, administer antibiotics and corticosteroids, and prepare client for ileostomy placement if no improvement is shown within 72 hours.