A 60-year-old patient with a history of peptic ulcer disease is admitted to the hospital with complaints of coffee-ground emesis and melena. What is the nurse's most appropriate initial action?

Encourage the patient to take deep breaths and relax.

Prepare the patient for an abdominal ultrasound.

Administer oral proton pump inhibitors as prescribed.

Initiate intravenous (IV) access and administer fluids as prescribed.

Answer and Explanation

The Correct Answer is D

A.   Encouraging the patient to relax and breathe deeply does not address the immediate concerns of potential hemorrhage.
B.   An abdominal ultrasound is not the first step in managing potential GI bleeding; stabilization is the priority.
C.   Proton pump inhibitors are important for managing peptic ulcer disease, but the immediate priority is
stabilizing the patient’s condition.
D.   Initiating IV access and administering fluids as prescribed is essential to stabilize the patient, manage shock, and address potential blood loss from gastrointestinal bleeding.

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Correct Answer is D

Explanation

A. Hyperactive bowel sounds are typically seen with diarrhea but are not a sign of hypokalemia.
B. Cerebral edema can occur with severe electrolyte imbalances, but it is not specifically related to hypokalemia caused by diarrhea.
C. Hypertension is not a typical symptom of hypokalemia; rather, hypokalemia often leads to low blood pressure.
D. Muscle weakness is a classic sign of hypokalemia because potassium is essential for proper muscle function, and low levels can impair contraction.

A. Increase the oxygen flow rate to 4 L/min to improve oxygenation. B. Switch the patient to a non-rebreather mask for better oxygenation. C. Continue to monitor the patient closely and reassess in 30 minutes. D. Reduce the oxygen flow rate to 1 L/min and notify the healthcare provider.

Correct Answer is D

Explanation

A. Increasing the oxygen flow rate could worsen respiratory depression in patients with COPD, as they rely on low oxygen levels to stimulate breathing.
B. Switching to a non-rebreather mask could further elevate the oxygen levels and may lead to hypoventilation or respiratory distress.
C. Monitoring the patient closely and reassessing in 30 minutes might be appropriate if the patient shows no immediate signs of respiratory distress, but the priority is to address the decreased respiratory rate.
D. Reducing the oxygen flow rate to 1 L/min and notifying the healthcare provider is the most appropriate action, as it may reduce the risk of respiratory depression caused by excessive oxygen.

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A 60-year-old patient with a history of peptic ulcer disease is admitted to the hospital with complaints of coffee-ground emesis and melena. What is the nurse's most appropriate initial action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has diarrhea. Which of the following findings is a manifestation of hypokalemia?

Correct Answer is D

Explanation

A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at 2 L/min via nasal cannula. After assessing the patient, the nurse notes increased drowsiness and a decreased respiratory rate. What is the most appropriate action for the nurse to take?

Correct Answer is D

Explanation

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A nurse is teaching a client who has multiple sclerosis about factors that can worsen their manifestations. Which of the following factors should the nurse include in the teaching?

A nurse is assessing a patient diagnosed with peptic ulcer disease. Which findings would support this diagnosis? (Select All that Apply.)

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