An intubated patient is receiving continuous enteral feedings through a Salem sump tube at a rate of 60ml/hr. Gastric residuals have been 30-40ml when monitored Q4H. You check the gastric residual and aspirate 220ml. What is your first response to this finding?
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Solution
Stop the feeding, and clamp the NG tube.
A gastric residual greater than 2 hours worth of feeding or 100-150ml is considered too high. The feeding should be stopped; NG tube clamped, and then allow time for the stomach to empty before additional feeding is added.
The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient’s diet?
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Solution
Meats and beans.
Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize protein adequately, causing protein by-products to build up in the body rather than be excreted.
A patient has a severe exacerbation of ulcerative colitis. Long-term medications will probably include:
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Solution
Corticosteroids.
Medications to control inflammation such as corticosteroids are used for long-term treatment.
Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication?
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Solution
Bowel perforation.
An inflammatory condition that affects the surface of the colon, ulcerative colitis causes friability and erosions with bleeding. Patients with ulcerative colitis are at increased risk for bowel perforation, toxic megacolon, hemorrhage, cancer, and other anorectal and systemic complications.
You’re preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he’s anxious. What should your initial step be in working with this patient?
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Solution
Determine what the patient already knows about colostomies.
Initially, you should assess the patient’s knowledge about colostomies and how it will affect his lifestyle.
You promote hemodynamic stability in a patient with upper GI bleeding by:
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Solution
Giving blood, electrolyte and fluid replacement.
To stabilize a patient with acute bleeding, NS or LR solution is given I.V. until BP rises and urine output returns to 30ml/hr.
A patient has an acute upper GI hemorrhage. Your interventions include:
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Solution
Treating hypovolemia.
A patient with an acute upper GI hemorrhage must be treated for hypovolemia and hemorrhagic shock. You as a nurse can’t diagnose the problem. Controlling the bleeding may require surgery or intensive medical treatment.
Dark, tarry stools indicate bleeding in which location of the GI tract?
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Solution
Upper GI tract.
Melena is the passage of dark, tarry stools that contain a large amount of digested blood. It occurs with bleeding from the upper GI tract.
What information is correct about stomach cancer?
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Solution
Stomach pain is often a late symptom.
Stomach pain is often a late sign of stomach cancer; outcomes are particularly poor when cancer reaches that point. Surgery, chemotherapy, and radiation have minimal positive effects. TPN may enhance the growth of cancer.
Findings during an endoscopic exam include a cobblestone appearance of the colon in your patient. The findings are characteristic of which disorder?
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Solution
Crohn’s disease
Crohn’s disease penetrates the mucosa of the colon through all layers and destroys the colon in patches, which creates a cobblestone appearance.