Nursing Elites

1. A client had an abdominal perineal resection with a colostomy 4 days ago and is ready for discharge. Which of the following would be an appropriate expected outcome at this point?

• A. The client maintains a high-fiber diet.
• B. The client discusses concerns about his sexual functioning.
• C. The client maintains bedrest.
• D. The client limits fluid intake to 1000 ml/day.

Correct answer: B

Rationale: Clients often have concerns about their sexuality after a fecal diversion. The nurse should encourage the client to discuss any questions about sexual functioning. The client will not need to maintain a high-fiber diet but will be encouraged to avoid any foods that cause odor and flatulence. The client should be able to ambulate and sit out of bed for several hours at a time at this point. Fluid intake will be encouraged, not restricted.

2. A client with which of the following conditions may be likely to develop rectal cancer?

• A. Adenomatous polyps
• B. Diverticulitis
• C. Hemorrhoids
• D. Peptic ulcer disease

Correct answer: A

Rationale: Adenomatous polyps are a known risk factor for the development of rectal cancer.

3. Which of the following expected outcomes would be most appropriate for a client with peptic ulcer disease? The client will:

• A. verbalize absence of epigastric pain.
• B. accept the need to inject himself with vitamin B12 for the rest of his life.
• C. understand the need to increase his exercise activity.
• D. eliminate stress from his life.

Correct answer: A

Rationale: A realistic goal for this client would be to gain relief from epigastric pain. There is no need for vitamin B12 injections because this client has not had any gastric surgery that would lead to vitamin B12 deficiency. Exercise should be modified, not increased, because it can stimulate further production of gastric acid. It is not possible to eliminate stress from a client's life. Instead, the client should be assisted to develop effective coping and problem-solving strategies as necessary.

4. To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instructions?

• A. Lie down after meals to promote digestion.
• B. Avoid coffee and alcoholic beverages.
• C. Take antacids before meals.
• D. Limit fluids with meals.

Correct answer: B

Rationale: To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that tend to increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client doesn't need to limit fluids with meals as long as the fluids aren't gastric irritants.

5. Your patient with peritonitis is NPO and complaining of thirst. What is your priority?

• A. Increase the I.V. infusion rate.
• B. Use diversion activities.
• C. Provide frequent mouth care.
• D. Give ice chips every 15 minutes.

Correct answer: C

Rationale: The correct answer is C: Provide frequent mouth care. In a patient with peritonitis who is NPO and thirsty, the priority is to maintain oral hygiene and provide comfort by moistening the mouth with frequent mouth care. This helps alleviate the sensation of thirst and maintains oral health. Increasing the IV infusion rate (choice A) may not address the patient's discomfort directly related to thirst. Using diversion activities (choice B) is not as critical as addressing the patient's immediate need for oral care. Giving ice chips every 15 minutes (choice D) is not recommended for a patient with peritonitis who is NPO, as it can lead to complications or worsen the condition.

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