Question

A nurse is providing discharge instructions to a client who has a peptic ulcer. Which information should the nurse include in the teaching?

Answer 1

Correct Answers:

"Monitor for black-colored stool."

Rationale :

🌼 A peptic ulcer involves erosion of the gastric or duodenal mucosa and places the client at risk for gastrointestinal bleeding.

🌼 When bleeding occurs in the upper GI tract, blood is digested as it passes through the intestines, resulting in black, tarry stools (melena).

🌼 Melena is a classic sign of upper gastrointestinal hemorrhage, which is a serious complication requiring immediate evaluation.

🌼 Clients must be educated to report black stools promptly because continued bleeding can lead to hypovolemia, anemia, and shock.

🌼 Therefore, monitoring for black-colored stool is essential in discharge teaching for peptic ulcer disease.

❌ "Monitor for red-colored urine."

Red-colored urine is associated with urinary tract conditions, not upper gastrointestinal bleeding. Peptic ulcers affect the stomach or duodenum, not the urinary system.

❌ "Monitor for yellowing of the eyes."

Yellowing of the eyes (jaundice) is linked to liver or biliary disorders. It is not a common complication of peptic ulcer disease.

❌ "Monitor for weight gain."

Weight gain is not a typical sign of peptic ulcer complications. Clients with ulcers more commonly experience weight loss due to pain with eating.

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Answer 2

Correct Answers:

Don a gown and gloves before entering the room.

Rationale :

🌿 Clostridium difficile is transmitted through spore-forming organisms that survive on surfaces and spread via the fecal-oral route.

🌿 Clients with C. diff require contact precautions, which include wearing a gown and gloves before entering the room to prevent transmission.

🌿 The spores are resistant to alcohol-based hand sanitizers, making barrier protection essential in infection control.

🌿 Proper use of personal protective equipment (PPE) reduces contamination of clothing and skin.

🌿 Therefore, donning gown and gloves prior to room entry is a critical component of care.

❌ Wash hands for 10 seconds after caring for the client.

Handwashing is required, but 10 seconds is insufficient for effective removal of spores. Proper hand hygiene requires thorough washing with soap and water for at least 20 seconds.

❌ Apply a mask on the client when they are outside their room.

C. diff is not transmitted via airborne droplets. Masks are not required unless another infection warrants airborne or droplet precautions.

❌ Administer loperamide with each meal.

Antidiarrheal medications like loperamide are generally avoided in C. diff because they may retain toxins in the bowel. Slowing intestinal motility can worsen the infection.

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Answer 3

Correct Answers:

"Avoid canned soups, processed meats, and prepackaged dinners."

Rationale :

🍃 Clients with cirrhosis commonly develop ascites and fluid retention due to portal hypertension and decreased albumin production.

🍃 Sodium causes the body to retain water, which worsens edema and ascites, so dietary sodium restriction is a key component of management.

🍃 Canned soups, processed meats, and prepackaged foods are typically very high in hidden sodium, even if they do not taste salty.

🍃 Reducing sodium intake helps prevent worsening abdominal distention, shortness of breath, and discomfort from fluid accumulation.

🍃 Therefore, teaching the client to avoid high-sodium processed foods is essential in managing cirrhosis complications.

❌ "Report an increase or decrease of one (1) pound or more to your healthcare provider."

Clients with cirrhosis are usually instructed to report rapid weight changes, but typically 2 pounds in 24 hours or 5 pounds in a week is the concerning threshold. A one-pound change may reflect normal daily fluctuation.

❌ "Take no more than three (3) grams of acetaminophen per day."

Acetaminophen must be used cautiously in liver disease, and many providers recommend lower limits than 3 grams. Clients should consult their provider before using hepatotoxic medications.

❌ "Ensure that you eat a few big meals per day to keep your protein and calories up."

Clients with cirrhosis are encouraged to eat small, frequent meals, not large meals. Large meals may worsen abdominal discomfort and are not ideal for metabolic stability.

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Answer 4

Correct Answers:

Position the residual limb flat on the bed.

Rationale :

🌟 After a below-the-knee amputation (BKA), preventing hip and knee flexion contractures is a major priority in the early postoperative period.

🌟 Prolonged flexion of the limb can lead to permanent contractures, which interfere with future prosthetic fitting and mobility.

🌟 Positioning the residual limb flat on the bed promotes proper extension and alignment.

🌟 Clients are also encouraged to lie prone several times daily (if tolerated) to stretch the hip flexors and prevent contracture formation.

🌟 Therefore, maintaining the limb in a flat, extended position is essential to preserve function and promote optimal rehabilitation outcomes.

❌ Place the bed in a reverse Trendelenburg's position.

Reverse Trendelenburg does not address contracture prevention of the residual limb. Limb positioning and joint alignment are higher priorities.

❌ Place pillows under the left knee.

Placing pillows under the knee promotes flexion contractures, which can delay rehabilitation and prosthetic use. This positioning should be avoided.

❌ Keep the residual limb open to air.

The incision site is typically covered with a sterile dressing or rigid dressing for protection. Exposure to air is not the immediate priority on postoperative day 2.

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Answer 5

Correct Answers:

An 80 year-old client admitted with dehydration and pneumonia receiving IV vancomycin.

Rationale :

💎 Elderly clients are at increased risk for acute kidney injury (AKI) due to age-related decline in glomerular filtration rate (GFR).

💎 Dehydration causes decreased renal perfusion, leading to prerenal AKI.

💎 Vancomycin is a nephrotoxic medication that can cause direct renal tubular damage, especially when combined with hypovolemia.

💎 The combination of advanced age, infection, dehydration, and nephrotoxic antibiotics significantly increases AKI risk.

💎 Therefore, this client has multiple compounding risk factors that place them at the highest likelihood of developing renal injury.

❌ A 54 year-old client with atrial fibrillation receiving IV push metoprolol.

Metoprolol is not nephrotoxic and does not typically impair renal perfusion. This scenario lacks dehydration or kidney stressors.

❌ A 67 year-old preoperative client receiving IV cefazolin.

Cefazolin is generally safe and not strongly nephrotoxic in routine prophylactic doses. There are no additional renal risk factors presented.

❌ A 28 year-old client with UTI receiving IV fluids and PO ciprofloxacin.

This client is young and receiving hydration, which protects kidney perfusion. Ciprofloxacin has minimal nephrotoxicity compared to vancomycin.

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Answer 6

Correct Answers:

84

Rationale :

Step 1: Convert pounds to kilograms

185 lb ÷ 2.2 = 84.1 kg

Step 2: Apply dosage order

1 mg/kg × 84.1 kg = 84.1 mg

Step 3: Round appropriately

Administer 84 mg per dose

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Answer 7

Correct Answers:

The client has absent bowel sounds in all quadrants.

Rationale :

🌟 After colorectal surgery, monitoring for return of bowel function is essential to detect complications such as paralytic ileus.

🌟 Absent bowel sounds on postoperative day 3 may indicate delayed gastrointestinal motility.

🌟 Ileus can lead to abdominal distention, nausea, vomiting, and possible bowel obstruction, which are serious complications.

🌟 Early recognition allows for interventions such as bowel rest, NG decompression, and provider notification.

🌟 Therefore, absent bowel sounds are the most urgent finding to address.

❌ The client requires the use of a colostomy bag.

A colostomy is expected after certain colorectal surgeries. This is not a complication but a planned outcome.

❌ The client has a loss of appetite following surgery.

Mild appetite loss is common postoperatively due to anesthesia and pain. It does not immediately indicate a life-threatening complication.

❌ The client reports moderate pain at the surgical site when sitting up.

Postoperative pain is expected and manageable with analgesics. It does not suggest a serious complication unless severe or worsening.

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Answer 8

Correct Answers:

Limiting oral fluids

Rationale :

🔶 During an acute gout attack, adequate hydration is essential to help the kidneys excrete excess uric acid.

🔶 Gout results from accumulation of monosodium urate crystals in joints due to elevated uric acid levels.

🔶 Limiting oral fluids can worsen hyperuricemia by reducing renal clearance of uric acid.

🔶 Clients are typically encouraged to drink at least 2–3 liters of water daily (unless contraindicated) to promote uric acid elimination.

🔶 Therefore, restricting fluids indicates the client needs further instruction about proper gout management.

❌ Taking naproxen

Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) commonly used to reduce pain and inflammation during acute gout attacks. It is an appropriate first-line treatment.

❌ Avoiding red meat

Red meat is high in purines, which metabolize into uric acid and can trigger gout flares. Avoiding high-purine foods is recommended.

❌ Restricting alcohol intake

Alcohol, especially beer, increases uric acid production and decreases its excretion. Limiting alcohol intake helps prevent future gout attacks.

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Answer 9

Correct Answers:

75

Rationale :

🔷 1800 mL ÷ 24 hours = 75 mL/hr.

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Answer 10

Correct Answers:

Peaked T waves on ECG

Rationale :

⚡ Clients with acute kidney injury (AKI) have impaired ability to excrete potassium, leading to hyperkalemia.

⚡ Elevated potassium levels affect cardiac conduction and produce characteristic peaked (tall, narrow) T waves on ECG.

⚡ As hyperkalemia worsens, ECG changes may progress to widened QRS complexes, ventricular dysrhythmias, and cardiac arrest.

⚡ Early recognition of peaked T waves is critical because hyperkalemia is a life-threatening electrolyte imbalance.

⚡ Therefore, peaked T waves strongly indicate elevated serum potassium levels requiring immediate intervention.

❌ Decreased skin turgor

Decreased skin turgor is a sign of dehydration. It does not directly indicate hyperkalemia.

❌ 2+ pedal edema

Peripheral edema suggests fluid retention, not necessarily elevated potassium levels. Hyperkalemia primarily presents with cardiac conduction abnormalities.

❌ Prominent U wave on ECG

Prominent U waves are associated with hypokalemia, not hyperkalemia. This finding indicates low potassium levels.

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QLexNursing

1 :
A nurse is providing discharge instructions to a client who has a peptic ulcer. Which information should the nurse include in the teaching?

2 :
A nurse is caring for a client who has Clostridium difficile gastroenteritis. Which action should the nurse include in the plan of care?

3 :
A nurse is preparing discharge instructions for a client who has cirrhosis of the liver. Which statement should be included in the education materials?

4 :
The nurse is caring for a client on the second postoperative day following a left below-the-knee amputation (BKA). Which is the priority nursing action at this time?

5 :
Which client is at greatest risk for developing acute kidney injury (AKI)?

6 :
A nurse is caring for a client who is postoperative following knee arthroplasty and has a new prescription for enoxaparin 1 mg/kg/dose subcutaneous every 12 hr. The client weighs 185 lb. How many mg should the nurse administer per dose?

7 :
A nurse is caring for a client with colorectal cancer who is postop day 3 from surgery to redirect intestinal contents out of the body. Which finding is most important to address to avoid a serious complication?

8 :
The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states they are taking which action?

9 :
A nurse is preparing to administer total parenteral nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr?

10 :
The nurse is caring for a client with acute kidney injury caused by severe dehydration and ibuprofen misuse. Which finding suggests an elevated serum potassium level?

QLexNursing

1 : A nurse is providing discharge instructions to a client who has a peptic ulcer. Which information should the nurse include in the teaching?

2 : A nurse is caring for a client who has Clostridium difficile gastroenteritis. Which action should the nurse include in the plan of care?

3 : A nurse is preparing discharge instructions for a client who has cirrhosis of the liver. Which statement should be included in the education materials?

4 : The nurse is caring for a client on the second postoperative day following a left below-the-knee amputation (BKA). Which is the priority nursing action at this time?

5 : Which client is at greatest risk for developing acute kidney injury (AKI)?

6 : A nurse is caring for a client who is postoperative following knee arthroplasty and has a new prescription for enoxaparin 1 mg/kg/dose subcutaneous every 12 hr. The client weighs 185 lb. How many mg should the nurse administer per dose?

7 : A nurse is caring for a client with colorectal cancer who is postop day 3 from surgery to redirect intestinal contents out of the body. Which finding is most important to address to avoid a serious complication?

8 : The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states they are taking which action?

9 : A nurse is preparing to administer total parenteral nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr?

10 : The nurse is caring for a client with acute kidney injury caused by severe dehydration and ibuprofen misuse. Which finding suggests an elevated serum potassium level?

1 :
A nurse is providing discharge instructions to a client who has a peptic ulcer. Which information should the nurse include in the teaching?

2 :
A nurse is caring for a client who has Clostridium difficile gastroenteritis. Which action should the nurse include in the plan of care?

3 :
A nurse is preparing discharge instructions for a client who has cirrhosis of the liver. Which statement should be included in the education materials?

4 :
The nurse is caring for a client on the second postoperative day following a left below-the-knee amputation (BKA). Which is the priority nursing action at this time?

5 :
Which client is at greatest risk for developing acute kidney injury (AKI)?

6 :
A nurse is caring for a client who is postoperative following knee arthroplasty and has a new prescription for enoxaparin 1 mg/kg/dose subcutaneous every 12 hr. The client weighs 185 lb. How many mg should the nurse administer per dose?

7 :
A nurse is caring for a client with colorectal cancer who is postop day 3 from surgery to redirect intestinal contents out of the body. Which finding is most important to address to avoid a serious complication?

8 :
The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states they are taking which action?

9 :
A nurse is preparing to administer total parenteral nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr?

10 :
The nurse is caring for a client with acute kidney injury caused by severe dehydration and ibuprofen misuse. Which finding suggests an elevated serum potassium level?