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Overdose of which of the following over-the-counter medications is one of the leading causes of liver failure in the United States?
Acetaminophen causes more liver failure in the United States than viral hepatitis, making it one of the most common causes of liver-related emergency room visits. It causes approximately 78,000 emergency room visits and 150 deaths due to liver failure each year. None of the other medications listed are associated with liver failure.
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The majority of hepatic infections are with which of the following type of microbe?
The majority of liver infections are viral in nature. Hepatitis A, hepatitis B, and hepatitis C are the most frequent agents of infection, with hepatitis C being the leading cause of liver transplants. Bacterial infections in the liver most commonly take the form of an abscess. Fungal hepatitis and prion infection of the liver are not generally seen.
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Which of the following viruses can cause hepatitis?
There are multiple viruses that can cause hepatitis other than hepatitis A, B, or C. Among these are Epstein-Barr virus, cytomegalovirus, and yellow fever.
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Which of the following describes a calcium carbonate preparation?
Calcium carbonate preparation is rapid-acting, releasing carbon dioxide in the stomach, causing belching and flatulence. Calcium carbonate is an antacid which reacts quicly with HCl to form CaCL2 and carbon dioxide.
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Which of the following does the nurse not recognize as a medication regimen for treating Helicobacter Pylori infections?
Multiple therapies are required to treat Helicobacter Pylori infections. Colestipol is a bile acid sequestrant used to lower blood cholesterol, which is not used to treat Helicobacter Pylori infections ( a bacterium that colonizes the human stomach).
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A female client with advanced cirrhosis of the liver has noticed that her abdomen has become greatly distended and she is concerned about her body image. The client asks the nurse "What is causing my stomach to look so big?"
The nurse responds based on her knowledge of liver disease and possible signs and symptoms. She tells the client which of the following explanations for her distended abdomen?
Portal hypertension causes proteins to move from the bloodstream into the lymphatics which cannot handle the excess and they leak into to abdominal cavity. The proteins causes an osmotic pressure pulling fluid into the space leading to ascites. Hypoalbuminemia will lead to decreased colloid oncotic pressure as well, also contributing to ascites.
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What foods must be avoided in Celiac disease?
Celiac disease is an autoimmune condition that is triggered by ingestion of gluten, a protein found in wheat, barley, and rye. A wheat-free diet is not sufficient for a patient with Celiac disease, as many other products contain elements of barley or rye and thus also contain gluten.
Oat, while often avoided by individuals with Celiac disease due to cross-contamination during processing, does not contain gluten. Whole dairy products are also generally gluten-free and considered safe for patients with Celiac disease.
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Samantha is a registered nurse working in the intensive care unit with a patient recently diagnosed with _Clostridium difficil_e. She violates Clostridium difficile contact precautions by __________.
Clostridium difficile (C. diff) is an infection caused by Clostridium difficile bacteria and requires contact precautions. Contact precautions state that nurses must wear gloves and a gown while caring for the patient. Nurses must also preform adequate hand hygiene before and after the use of gloves. Additionally, because C. diff infections are caused by spores, alcohol gel alone may not be sufficient to eliminate the bacteria. Current practice is the use of soap and water to cleanse hands. Afterwards, nurses may utilize alcohol-based hand gel. It is acceptable to place a C. diff patient in a semi-private room with another C. diff patient if private rooms are unavailable.
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Carrie is caring for an 85-year-old woman in a long-term care facility. Her patient has been taking antibiotics for the past two weeks to treat a severe case of cellulitis. Carrie notices that her patient has developed a fever, has refused her last two meal trays, and is complaining of abdominal pain. Which of the following samples should Carrie seek permission to obtain?
It is possible that this patient is suffering from a Clostridium difficile infection caused by bacteria. The presence of an underlying condition, increasing age, and antibiotic use are all risk factors for contracting Clostridium difficile. A stool sample is commonly used to test for the bacteria. Until the results are available, Carrie should place the patient under proper C. difficile contact precautions.
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Which of the following bacterial species is responsible for the development of peptic ulcers?
Helicobacter pylori or H. pylori is the bacterial cause of peptic ulcers. Staphylococcus aureus is a bacteria that frequently causes skin infections along with other conditions such as toxic shock syndrome. Streptococcus faecalis is responsible for many urinary tract infections and contracting Viridans streptococci may result in endocarditis. Treponema pallidum bacteria cause syphilis.
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A 35-year-old client is being discharged post hemorrhoidectomy surgery. The nurse is explaining in detail all discharge instructions to be followed for a successful postoperative period.
The client will need to adhere to which of the following instructions?
To prevent pain during a bowel movement post operatively, pain medication is often indicated to help make it more tolerable. Pain medications will need to be given post op and may contribute to constipation, but oral stool softeners and and a high fiber diet can help to avoid the constipation. Rectal suppositories and daily enemas are not needed. Bowel movements should not be delayed nor avoided in the post operative period.
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A client is being treated on the medical-surgical unit for pneumonia and has recently developed severe diarrhea. Upon cultures performed it has been determined the client is now carrying Clostridium Difficile (C-diff), and will need to be on special precautions to prevent the spread of this disease.
All of the following are consistent with the appropriate precautions when dealing with those infected with C. difficile except __________.
This client is to be on contact precautions, the wearing of a mask is consistent with airborne precautions which is not necessary for C-diff. All other choices are appropriate for contact precautions.
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The nurse is caring for a 25-year old-patient diagnosed with a poorly functioning lower esophageal sphincter. The nurse may advise the patient to do which of the following?
Several foods can cause relaxation or irritation of the lower-esophageal sphincter. Alcohol, carbonated beverages, and chocolate are a few examples. Advise the patient to remain upright after meals, to utilize antacids when appropriate, and to practice a balanced diet.
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Which of the following GERD medications works by neutralizing stomach acid?
Magnesium hydroxide is a strong base. It works by neutralizing the acid in the stomach, forming water and magnesium chloride. All other listed medications work to prevent the stomach from over-producing acid, rather than neutralizing the existing acid in the stomach.
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Which of the following patients is most at risk for the development of a hiatal hernia?
Advanced age, female sex, obesity, alcohol use, frequent heavy lifting, pregnancy, gastrointestinal tumors, and smoking may increase an individual's risk for the development of a hiatal hernia. The correct scenario represents four risk factors.
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The nurse cares for a patient with appendicitis. Which of the following positions is best for improving breathing and relieving abdominal pain?
Fowler’s position (head of bed (HOB) elevated 45 degrees) increases comfort, ventilation, circulation, and relieves pressure from the thorax. It would be best for this patient due to the pain experienced by the patient in the abdomen. Sims’ position (halfway between lateral and prone, upper arm flex, lower arm behind patient) is used when a patient is receiving an enema or an examination in the perineal area. Trendelenburg (HOB lowered, feet elevated) is used for patients with hypotension, as it promotes venous return. Reverse Trendelenburg (HOB elevated, feet lowered) is used to promote gastrointestinal problems by minimizing esophageal reflux. Side-lying (patient on side with top leg in front of bottom leg and hip/knee flexed) is used to relieve pressure from the sacrum and is often rotated with patients who are on bedrest.
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You are the nurse for a new patient brought to the emergency department for a suspected gastrointestinal bleed. The patient is tachycardic and hypotensive, but conscious, responsive, and breathing spontaneously without any airway trouble. Which of the following is the best initial intervention?
The correct answer in this question is "Insert two large-bore peripheral IV's."
This is the correct answer because this patient is suffering from a suspected gastrointestinal bleed and based upon the report of the vital signs, he is hemodynamically unstable. In evaluating an emergency/trauma patient, the "ABC's" must be assessed (A= airway, B= breathing, C= circulation). In this patient's case, it is stated that he is responsive and breathing without any issues, indicating that his airway and breathing are both satisfactory. The next issue is his circulation. Given that he has a suspected bleed, and is tachycardic and hypotensive, it is likely that he is losing a significant amount of blood from his bleeding viscera. As such, he may need emergent, rapid fluid and/or blood product resuscitation. The best way to prepare for this immediately is to place two large bore peripheral IV lines, such that resuscitation can be provided through these lines while the rest of the workup and treatment continues. Any delay in placing these lines delays the fluid/blood resuscitation of the patient, which can be dangerous.
At this point, given that the patient has a protected airway and is breathing without issue, intubation would not be indicated. Should his airway or breathing status change, the need can be reassessed.
Administering hydromorphone, a potent opioid, may be necessary if the patient is in a significant amount of pain, but that would not be the most pressing initial concern given that he is hemodynamically unstable.
Administering warfarin, an anticoagulant, would be highly contraindicated in this patient, as he likely has an active gastrointestinal bleed and is hemodynamically unstable.
Administering lorazepam, a benzodiazepine, is not indicated in this hemodynamically unstable patient with a suspected gastrointestinal bleed. After stabilization and continued demonstration of airway protection, if the patient is anxious, this need can be reassessed.
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You are the nurse at a primary care clinic taking care of a 40-year old male who is undergoing his routine annual well-check. His only complaint is that about once per month, when eating spicy food or drinking significant amounts of alcohol, he experiences heartburn. Which of the following would be the most appropriate recommendation?
The correct answer is "Take 1-2 tablets of calcium carbonate every 3-6 hours as needed for heartburn symptoms, and if you experience symptoms more frequently or severely, return to clinic." This answer is correct because in this patient's case, he is an apparently healthy 40-year old male whose only complaint is very infrequent heartburn that occurs in response to specific trigger foods and drinks (spicy foods and alcoholic beverages). In a patient who experiences mild to moderate heartburn, or acid reflux, symptoms infrequently, meaning less than 3 times per week, the appropriate initial recommendation is to take over-the-counter calcium carbonate tablets as needed, as these will directly neutralize the excess acid in the distal esophagus and stomach. For the majority of patients with infrequent heartburn brought on by known trigger foods and beverages, this will be sufficient to provide symptomatic relief.
It is inappropriate in a patient with infrequent heartburn who has not yet tried (and failed) calcium carbonate to initiate ranitidine or omeprazole treatment, as these are more potent methods to suppress intrinsic stomach acid production, and are not necessarily required to provide symptomatic relief for these patients. If the patient in this example was experiencing more frequent heartburn, more severe heartburn, or heartburn that was not adequately controlled by calcium carbonate, then ranitidine or omeprazole would be reasonable options.
The best initial treatment option for a patient with heartburn is not acetaminophen, an over-the-counter analgesic. Heartburn is caused by reflux of acidic gastric contents into the distal esophagus. The best initial treatment for an acute episode of heartburn is calcium carbonate, as this will directly neutralize the acid that is causing symptoms, and provide symptomatic relief for most patients.
It would be inappropriate to send this patient immediately to the emergency room as he is not currently experiencing heartburn symptoms, his symptoms are highly consistent with heartburn (as opposed to a cardiac etiology), given that they are brought on only infrequently and directly in response to trigger foods and beverages. If the patient was actively complaining of chest pain, and more concerning aspects of his pain were elicited that suggested a cardiac etiology, then an immediate referral to an emergency department would be a more valid consideration.
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You are the nurse taking care of an 83-year old patient with a history of gastroesophageal reflux disease (GERD). They complain that they are having heartburn symptoms at night when trying to go to sleep and in the morning when they wake up. In addition to addressing their medical therapy options, you recommend which of the following to the patient:
The correct recommendation is "Eat your last meal at least 3 hours prior to going to bed, and sleep as upright as possible, with multiple pillows." This is correct because this recommendation involves fairly simple lifestyle changes that have the potential to greatly decrease the patient's symptom burden. Heartburn symptoms can be exacerbated in patients who eat spicy foods (at any time), who drink coffee, and/or who eat meals shortly prior to going to bed (since the food can physically reflux back to the distal esophagus from the stomach prior to being digested more completely). Thus, any of those recommendations would be inappropriate. Further, in a patient who is acutely experiencing acid reflux symptoms, it is typically appropriate for them to take calcium carbonate to neutralize the acid and relieve symptoms. As such, advising the patient to not eat immediately prior to going to bed, and to remain upright (to physically minimize reflux of contents) would be the most appropriate recommendation.
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You are a nurse at an oncology infusion center taking care of a 45-year old female with breast cancer, currently being treated with chemotherapy. While receiving her chemotherapy infusion, she complains of severe nausea. Which of the following medications would be most appropriate to treat this patient's nausea assuming she has a normal QTc interval?
The correct answer is "ondansetron." This is the correct answer because this patient, who is actively being treated with chemotherapy and experiencing severe nausea, is most likely suffering from chemotherapy-induced nausea. The most appropriate first-line treatment for chemotherapy-induced nausea in a patient with a normal QTc interval is ondansetron (also known as Zofran). Ondansetron is a serotonin 5HT-3 receptor antagonist, likely accounting for its anti-nausea properties. A side effect is QTc interval prolongation, and as such, careful consideration as to whether or not to prescribe ondansetron should be given for patients with baseline prolonged QTc intervals.
Acetaminophen, an analgesic, would not treat nausea, nor would ibuprofen, meloxicam, or ketorolac (all NSAID medications).
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