Question

1. The nurse is counseling a client with a poor appetite and weight loss. Which priority intervention should the nurse recommend?

1. Eat your favorite foods to get additional calories, no matter what they are.
2. Consume high protein, high-calorie replacement drinks between meals.
3. Take a daily vitamin.
4. Eat 6 small meals each day.

2. A client is prescribed a diet that can be advanced as tolerated. How does the nurse recognize that the client is ready to be started on regular food? Select all that apply:

1. Bowel sounds are present.
2. Hunger is verbalized.
3. The client has been NPO for 5 days.
4. The albumin level is within normal range.
5. The health care provider says so.

Nurses Notes and Labs
September 7  - 0330
Admitted with severe abdominal pain radiating to the back, nausea, vomiting and a fever. Pain 8/10 HR 122, Blood Pressure 147/96, Respiration 22, Temp 101.4, Sats = 92% on RA. History of DM type 2, Admits to heavy alcohol use, hypertension, and hemorrhoids, Admit to medical floor.
WBC 14,000 u/L	Glucose 322 mg/dl	Hgb 6.8 g/dL	Amylase 459 U/L

3. A client is admitted with abdominal pain. Based on the information found in the record above, what should the nurse requests as “recommendation(s)” for admission orders in the SBAR conversation with the health care provider? Select all that apply:

1. Acetaminophen 1000 mg PO every 6 hours PRN pain.
2. Surgical consultation.
3. O2 at 2 L/NC PRN.
4. Regular insulin per sliding scale coverage.
5. Type and cross for 2 units PRBC.

4. Circle the client information that supports the nurse decision to give the 25% albumin.

Client Information		Resource Information
Medical Diagnosis	32 year old with advanced liver disease.	Medication	Albumin 25%
Current Vital Signs	T 97.8, HR 112, BP 98/62, Resp 24, Sats 95% on RA	Indications	Restores plasma volume after burns, hyperbilirubinemia, shock, hypoproteinemia, prevention of cerebral edema, cardiopulmonary bypass procedures, ARDS, nephrotic syndrome.
Medical History	ETOH x 16 years; smokes 2 packs/day x 18 years; peptic ulcer disease; total knee replacement 3 years ago; history of osteoarthritis.	Contraindications	Hypersensitivity, CHF, severe anemia, renal insufficiency, pulmonary edema.
Physical Exam	Orientated x 1; restless and confused; weak, S1S2 heart sounds, fine crackles in the lungs, ascites, 3+ edema, urine dark amber.	Interactions	Increased serum albumin
Lab Tests	Albumin 2.8 g/dL, Na= 147 mEq/L; K= 3.2 mEq/L; Ammonia 457; mcg/dL; PT 15.6 seconds; PTT 79 seconds.	Route/dose	Adult: IV 25 g, may repeat in 15-30 minutes, or 50-75 g of 25% albumin infused at <  2ml/min
Meds	Lactulose Vitamin K	Nursing Concerns	Slowly, to prevent fluid overload, dilute with NS for injection or D5W; 5% is given undiluted; 25% may be given diluted or undiluted; give over 30-60 min, use infusion pump, use large gauge needle, infusion must be completed in 4 hours.

5. The nurse is suggesting interventions for a client with chronic constipation. In which order should the nurse make these recommendations? Place then in order from 1^strecommendation to last recommendation.

1. Docusate.
2. Enema.
3. Increase fiber intake.
4. Bisacodyl.
5. Prune Juice.

6. The nurse is assessing a 41-year-old client in an outpatient clinic. Which indication of a risk factor for bowel disease requires follow-up by the nurse?

1. The client’s 62-year-old father was diagnosed with colorectal cancer 4 years ago.
2. The client’s cousin has inflammatory bowel disease and frequent diarrhea.
3. The client reports eating red meat 2 days a week and fish twice a week.
4. BMI of 24.8 kg/M²and has less than optimal nutritional patterns.

7. A client with a medical diagnosis of cirrhosis has been admitted to a medical unit, and the nurse is doing an assessment. What complaint from the client requires immediate follow-up?

1. Bloody expectorant with coughing episodes.
2. Jeans cannot zip because of enlarged abdomen.
3. Swelling in the feet and lower legs.
4. Yellowing of the eyes and mucous membranes.

            

8. The clinic nurse is interviewing a new client, who presents with increasing frequency of stools and says the last healthcare provider gave me a diagnosis of ulcerative colitis. Which statement by the client requires immediate follow-up?

1. “I am having more frequent loose stools than I did last week.”
2. “I have developed a high fever and severe abdominal pain since yesterday.”
3. “My last healthcare provider said I have a genetic link for developing the disease.”
4. “This is a depressing disease to have.”

9. A client returns from surgery for placement of a colostomy secondary to ulcerative colitis. Two hours after surgery the nurse is most concerned about which assessment?

1. Hypoactive bowel sounds in all four quadrants.
2. Decreased breath sounds in the bases of the lungs.
3. Slight distension of the bladder.
4. A blood pressure below the baseline value.

10. A 13-year-old client is receiving total parental nutrition as a treatment for Crohn’s disease.  The client asks the rationale for this treatment. Which statement by the nurse accurately describes the reason for this treatment?

1. “The nutrition in your intravenous line is more complete that what you can eat.”
2. “Total parenteral nutrition allows your intestines to rest and heal for a while. “
3. “This treatment assists you in getting the nutrients you need without the allergies.”
4. “With this treatment you do not need to eat by mouth so you can get the rest you need.”

11. A Nurse is caring for a client with colorectal cancer who is receiving total parental nutrition (TPN). The physician has prescribed the TPN to infuse at 150 ml/hr. The TPN bag holds 2400 ml. How long will it take for the TPN to infuse to the nearest whole hour? Fill in the blank.

12. The nurse is caring for these four clients. Which client would the nurse provide care to first?

1. 25-year-old who had a splenectomy four hours ago and is reporting pain at the incisional site with movement.
2. 75-year-old who had surgery three days ago for a bowel obstruction and has a fever, chills and purulent drainage from the wound.
3. 18-year-old diagnosed with infection who is receiving an intravenous antibiotic and reports tingling around the mouth and an itchy body.
4. 68-year-old who had a unit of packed red blood cells and hour ago and reports feeling fatigued and flushed.

13. A client is admitted with ascites from liver failure. Spirolactone 100 mg is administered. Which sign or symptom would designate a serious complication for the client?

1. Blurry vision.
2. Low potassium.
3. Increased thirst.
4. Leg pain.

14. A client on the surgical unit is preparing to be discharged after a colectomy for intestinal obstruction. The nurse finds the client passed out on the bathroom floor. Which response by the nurse would be most appropriate?

1. Call another nurse to help get the client back to bed.
2. Call the client’s healthcare provider from the room.
3. Check the client’s abdominal wound for bleeding.
4. Determine if the client is breathing and has a pulse.

15. Emergency Medical Services transports a known IV drug user to the Emergency Department. The client reports flu-like symptoms for the last week, jaundice, and inability to keep food down. What safety precautions should the nurse utilize?

1. Droplet precautions only.
2. Full gown, gloves, mask with shield.
3. Report the client to the CDC.
4. Standard precautions including gloves and handwashing.

Answer 1

1.A patient who has poor appetite should be given a food of choice and preferred food to encourage eating ,weight loss shoukd be balanced with adequate calorie.Protein is a must to improve weight in case of weight loss.So patient consuming high protein and high calorie drinks in between meals can be beneficial

Vitamin supplements should not be taken without prescription

Six meals can be beneficial but a patient who has anorexia could not stick with this

Ans:consume high protein, high calorie replacement drinks between meals

2.The following things indicates that the patient can be started with oral feeds like presence of bowel sounds,verbalized hunger, NPO after 5 days.

Albumin level being in normal range is not needed to initiate the progression of feeding type

Doctor order is needed in the initial stage to assess and give order to start orally

Ans:Bowel sounds are present

Hunger is verbalized

Client has been NPO for 5 days

The health care provider says so

3.The recommendations which can be fine by the nurse are

The patient needs a painkiller for abdominal pain and antipyretics to reduce fever

Oxygen to meet the normal oxygen saturation level

Regular insulin to keep blood glucose under control

Surgical consultation for hemorrhoids can be suggested but a provider has to see and then provide a reference

Blood transfusion for extremely low hemoglobin

Ans:Acetaminophen 1000mg PO every six hours PRN pain

O2at 2L NC PRN

Regular insulin per sliding scale coverage

Type and cross for 2 units PRBC

4.The normal albumin level is 3.4 to 5.4 g/dL and the advance liver disease can make nurse to de used to give 25% albumin

Ans:Lab test

Answer 2

Consume high protein. high calorie replacement drinks between meals