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Get faster at matching terms Chapter 5 Gastrointestinal Management Terms in this set (67)the nurse is caring for clients on a medical unit. which task should the nurse implement? assess the male client who called the desk to say he is nauseated and just vomited the nurse is preparing a client dx with peptic ulcer disease for
a barium study of the stomach and esophagus. which nursing intervention is the priority for this client? tell the client not to eat or drink anything prior to the procedure which client warrants immediate intervention from the nurse on the medical unit? pt with crohn's disease who has right lower abd pain and diarrhea the nurse and UAP are caring for pts on a med surg unit. which task should not be delegated to the UAP? instruct the UAP to feed the 69 yo client who is experiencing dysphagia which behavior by the UAP requires immediate intervention by the nurse? the UAP placed the pt with a continuous feeding tube in the supine position the nurse is concerned about the documentation form for blood administration, and other staff members agree the documentation is cumbersome and needs to be revised. which action is most appropriate for the nurse to implement first? volunteer to be on an ad hoc committee to research alternative flow sheets the charge nurse is transcribing HCP orders for a pt scheduled for a barium enema. in addition to the radiology dept, which dept of the hospital should be notified of the
procedure? the dietary dept the charge nurse is making assignments on a med unit. which pt should the nurse assign to the graduate nurse? the pt scheduled for a EGD in the morning which client should the nurse assess first after receiving the PM shift assessment? pt with abd pain who has an 8 hour UOP of 150 mL/hr the nurse is planning the care of a client dx with acute gastroenteritis. which nursing problem is priority? fluid and electrolyte imbalance the nurse is preparing to administer morning meds to pts on a med unit. which med should the nurse administer first? sucralfate (carafate), a mucosal barrier agent, to a pt diagnosed with ulcer disease the nurse has received the AM shift report on a surgical unit in a community hospital. which pt should the nurse assess first? pt who is 1 day post op for abd surgery and has a rigid, hard abd the charge nurse is reviewing the morning lab results. which data should the charge nurse report to the HCP via telephone? the pt who is 4 hours post op for gastric lap banding with WBC count of 15,000 mm the nurse is preparing pts for surgery. which client has the greatest potential for experiencing complications? the pt scheduled for an open cholecystectomy who smokes 2 packs of cigs per day the nurse is performing ostomy care for a client who had and abdominal-peritoneal resection with a permanent sigmoid colostomy. rank the following interventions in order of priority. monitor the drainage in the ostomy drainage bag, assess the stoma for a pink, moist appearance, cleanse the stomal site with mild soap and water, apply stoma adhesive paste to the skin around the stoma, attach the ostomy drainage bag to the abdomen the nurse is transcribing the HCP's orders for a client who is
schedule for an emergency appendectomy and is being transferred from the ED to the surgical unit. which order should the nurse implement first? obtain the pt's informed consent the client 1 day post op abd surgery has an evisceration of the
wound. which intervention should the nurse implement first? place sterile normal saline gauze on the eviscerated area the med surg nurse has just received the AM shift report. which client should the nurse assess
first? pt who is 6 hours post op and has an abd wound dehiscence the pt is being prepared for a colonoscopy in the day surgery center.
the charge nurse observes the primary nurse instructing the UAP to assist the pt to the bathroom. which action should the charge nurse implement? take no action bc this is appropriate delegation
the nurse is caring for pts on a surgical unit. which client should the nurse assess first? the pt who is 8 hours post op for splenectomy and who is complaining of abd pain, rating it a 9 out of 10 the UAP tells teh nurse angrily, "you are the worst nurse I have ever worked with and ai really hate working with you." which action should the nurse implement first? don't respond to the comment and appraise the situation the pt is admitted to the critical care unit after a motor vehicle accident. the client asks the nurse, "do you know if the person in the other car is all right?" the nurse knows the person died. which statement supports
the ethical principle of veracity? I am sorry to have to tell you, but the person died the pt admitted to the critical care unit tells the nurse, "I have an advance directive and I do not want
to have CPR." which intervention should the nurse implement first? inform the HCP of the pt's request as soon as possible the pt
is dx with esophageal bleeding. which fo the following assessment data warrants immediate intervention by the nurse? the pt's VS are T 99, AP 114, RR 18, BP 88/60 which task should the nurse in the long term care facility
delegate to the UAP? assist the resident up in a wheelchair for meals the nurse and UAP are caring for a client on a med unit who had difficulty swallowing and is incontinent of
urine and feces. which task should the nurse delegate to the UAP? apply non-medicated ointment to the pt's perineum which behavior by the UAP warrants intervention by the long term care
nurse? the UAP is giving the pt with a GT tube a glass of water the nurse is preparing to teach the male client how to irrigate his sigmoid colostomy.
which intervention should the nurse implement first? ask the pt whether he has any questions the LPN tells the nurse the pt dx with liver failure is getting more confused. which intervention should the nurse implement first? assess the pt's neuro status the nurse is changing the pt's colostomy bag. which interventions should the nurse implement? rank in order of priority don non-sterile gloves, removed the pt's colostomy bag, assess the pt's stoma site, cleanse the area around the pt's stoma, apply the pt's new colostomy bag which task is most appropriate for the home healthcare nurse to delegate to the UAP? tell the UAP to wash and dry the pt's hair which behavior by the UAP warrants intervention by the home health nurse? the pt tells the home health nurse the UAP: pick up the pt's prescriptions from the pharmacy the female pt, dx with diverticulitis, called the home healthcare agency and told the nurse, "I am having really bad pain in my L lower stomach and I think I have a fever." which action should the nurse take? tell the pt to have someone drive them to the ER the pt with a sigmoid colostomy has an excoriated area around the stoma that has not improved for more than 2 weeks. which intervention is most
appropriate for the home health nurse to implement? refer the pt to the wound care nurse the pt, who is terminally ill, tells the nurse "I just want to live to see my grandson graduate in 2 months." which stage of grief is the client
experiencing? bargaining the nurse is discussing end of life care with the pt dx with pancreatic cancer. which statements are the goals of end of life care? SATA to provide comfort and supportive care during the dying process, to improve the pt's quality of life for the remaining time, to help ensure a dignified death for the client and family the male mexican american pt, who is terminally ill, refuses hospice services because he says it is
"giving up" and he is not going to die. which is the most appropriate action by the nurse? discuss the philosophy and services of palliative care with the pt the
nurse is discussing end of life issues with a pt. the nurse is explaining about a document used for listing the person the pt will allow to make healthcare decision should he or she become unable to make informed decisions for him or herself. which document is the nurse discussing with the pt? durable POA for healthcare
the significant other of a pt dx with liver cancer and who is dying asks the nurse, "what is bereavement counseling?" which statement is the nurse's best response? it provides support to you and your family in the transition to a life without your loved one the nurse is working in a digestive disease disorder clinic. which nursing action is an example of evidenced-based practice (EBP)? educate a pt based on current published info the charge nurse notices a nurse recapping a needle in a pt's room. which action should the charge nurse take first? quietly ask the nurse to step into the hall the administrative supervisor is staffing the hospital's med surg units during an ice storm and has received many calls from staff members who are unable to get to the hospital. which action should the supervisor implement first? notify the on duty staff to stay the nurse is working in a community health clinic. which nursing task should the nurse delegate to the UAP? ask the UAP to obtain the pt's wt and ht the staff nurse is working with a colleague who begins to act erratically and is loud and argumentative. which action should be taken by the nurse? ask the supervisor to come to the unit the
charge nurse is making assignments on a med surg unit. which client should be assigned to the most experienced nurse? the pt diagnosed with GERD who has bilateral wheezes the pt is experiencing severe diarrhea and a serum K level of 3.3. which intervention should the nurse implement first? place the client on cardiac telemetry the UAP notifies the charge nurse that the
male pt is angry with the care he is receiving and is packing to leave the hospital. which intervention should the charge nurse implement first? discuss the problem with the pt the nurse is caring for a 14 yo female pt dx with bulimia. which intervention should the nurse
delegate to the UAP? list the dietician the amt of food the pt consumed the pt tells the nurse in the bariatric clinic, "I have tried to lose wt on about every diet out there but nothing
works." which statement is the nurse's best response? which diets and modifications have you tried? the pt 2 days post op from laparoscopic cholecystectomy tells the office nurse, "my R shoulder hurts so bad I
can't stand it." which statement is the nurse's best advice? this is a result of the carbon dioxide gas used in surgery the nurse is caring for a pt who is hemorrhaging from a duodenal ulcer.
which collaborative interventions should the nurse implement? SATA prepare to administer a sengstaken-blakemore tube, administer a proton-pump intravenously, obtain a type and crossmatch for four units of blood
the nurse is caring for a pt dx with peptic ulcer disease. which assessment data would cause the pt to require an immediate intervention by the nurse? pt has coffee ground emesis the nurse is caring for a client 1 day post op sigmoid
resection. there is a large amt of bright red blood on the dressing. which intervention should the nurse implement first? assess the client's apical pulse and BP the UAP tells the nurse a female pt, who had a laparoscopic cholecystectomy, is
complaining of abdominal pain, which intervention should the nurse implement first? assess the pt to rule out any post op surgical complications the
male pt is 30 mins post-procedure liver biopsy. which action by the UAP requires the nurse to intervene? the UAP turned the pt on the left side the pt dx with liver failure is experiencing pruritus secondary to severe jaundice and is scratching the
upper extremities. which intervention should the nurse implement first? place mittens on both hands of the pt the pt with hepatitis asks the nurse, "is there any herb I can take to help my liver get
better?" which statement is the nurse's best response? milk thistle is a powerful oxidant and promotes liver cell growth which task would be most appropriate for the nurse on the GI unit to
delegate to the UAP? tell the UAP to empty the pt's colostomy bag the pt is dx with gastroenteritis. which lab data warrants immediate intervention by the nurse? a serum Na of 152 which nursing problem is the highest priority for the pt dx with gastroenteritis from staphylococcal food poisoning? fluid and electrolyte imbalance the nurse has received the AM shift report. which client should the nurse assess first? pt with peptic ulcer disease who is complaining of acute epigastric pain the pt who has had abd surgery is complaining of pain and tells the nurse, "I felt something pop in my stomach." which intervention should the nurse implement first? assess the pt's surgical wound site the pt who is 2 days post op abd surgery has a hemovac drainage tube. which assessment data indicates the jp drain is functioning appropriately? the hemovac has suction and is compressed the nurse is caring for the following pts on a surgical unit. which client should the nurse assess first? the pt with an emergency appendectomy who was transferred form PACU the pt who is morbidly obese is 8 hours post op gastric bypass surgery. which nursing intervention is of the greatest priority? instruct the pt to use the incentive spirometer the charge nurse has complete report. which pt should be seen first? the pt with intractable vomiting who has tented skin turgor and dry mucous membranes the nurse, a LPN, and an UAP are caring for pts on a medical floor. which nursing task is most appropriate to assign/delegate? tell the LPN to administer a bulk laxative to a pt dx with constipation Sets found in the same folderPDM: Chapter 669 terms alexus_marie2 Management Quiz #468 terms Hannah_Bradford05 Leadership Final120 terms Ashley_Pederson1 EAQ Liver Diseases41 terms raquel_yniguez Other sets by this creatorICU Exam 599 terms howardkathryn ICU Exam 580 terms howardkathryn ICU Exam 549 terms howardkathryn ICU Exam 3 (Valve Replacement Surgery)33 terms howardkathryn Other Quizlet setsArea of emphasis WB Exam 2 (5,6,11,12,13)110 terms NetworkOp DMV California Drivers Test Parts 3 & 420 terms nick_grunden Business Law Midterm True/False, Business Law Chap…1,843 terms emmymarie123321 Fellowship III15 terms yeah2231234 Related questionsQUESTION THIS IS AN EVALUATION ERROR IN WHICH A FF IS RATED ON THE BASIS OF THE PERFORMANCE OF ANOTHER FF AND NOT ON THE CLASSIFIED JOB STANDARD 2 answers QUESTION ch. 7 - 11 The introduction of most aquatic herbicides into an aquatic environment requires restricting the use of the water until the herbicide has 2 answers QUESTION The Earthquake of 2011 in Japan, moved the city of Honshu 4.1 miles to the east and shifted the earth on its axis by approximately 5 inches. 11 answers QUESTION Purchasing can only negatively affect the long-term growth, revenue, and operating outcomes and plans of internal customers. 3 answers Which should the nurse assess first?Begin first with the patient who has the highest priority and progress to the patient who has the lowest priority. A nurse is performing a complete physical assessment of an adolescent.
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The nurse is caring for clients on a medical unit. which task should the nurse implement first?
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