The nurse is taking the health history of a patient being treated for Emphy- sema and Chronic Bronchitis. After being told the patient has been smoking cigarettes for 30 years, the nurse expects to note which assessment finding?
Increase in Forced Vital Capacity (FVC)
A narrowed chest cavity
Clubbed fingers
An increased risk of cardiac failure: 3. Clubbed fingers – CORRECT Clubbed fingers are a sign of a long-term, or chronic, decrease in oxygen levels.
The nurse is taking the health history of a 70-year-old patient being treated for a Duodenal Ulcer. After being told the patient is complaining of epigastric pain, the nurse expects to note which assessment finding?
Melena
Nausea
Hernia 1 / 4 2 / 23
Hyperthermia: 1. Melena – CORRECT Melena is the finding that there are traces of blood in the stool which presents as black, tarry feces. This is a common manifestation of Duodenal Ulcers, since the Duodenum is further down the gastric anatomy.
A nurse is providing discharge teaching for a patient with severe Gastroesophogeal Reflux Disease. Which of these statements by the patient indicates a need for more teaching?
“I’m going to limit my meals to 2-3 per day to reduce acid secretion.”
“I’m going to make sure to remain upright after meals and elevate my head when I sleep”
“I won’t be drinking tea or coffee or eating chocolate any more.”
“I’m going to start trying to lose some weight.”: 1. “I’m going to limit my meals to 2-3 per day to reduce acid secretion.” CORRECT – Large meals increase the volume and pressure in the 2 / 4 3 / 23 stomach and delay gastric emptying. It’s recommended instead to eat 4-6 small meals a day.
The nurse in the Emergency Room is treating a patient suspected to have a Peptic Ulcer. On assessing lab results, the nurse finds that the patient’s blood pressure is 95/60, pulse is 110 beats per minute, and the patient reports epigastric pain. What is the PRIORITY intervention? 3 / 4 4 / 23
Start a large-bore IV in the patient’s arm
Ask the patient for a stool sample
Prepare to insert an NG Tube
Administer intramuscular morphine sulphate as ordered: 1. Start a largebore IV in the patient’s arm CORRECT – The nurse should suspect that the patient is haemorrhaging and will need need a fluid replacement therapy, which requires a large bore IV.
A female patient with atrial fibrillation has the following lab results: Hemo- globin of 11 g/dl, a platelet count of 150,000, an INR of 2.5, and potassium of 2.7 mEq/L. Which result is critical and should be reported to the physician immediately?