Nursing Elites

1. A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:

• A. Absence of nausea and vomiting.
• B. Passage of mucus from the rectum.
• C. Passage of flatus and feces from the colostomy.
• D. Absence of stomach drainage for 24 hours.

Correct answer: C

Rationale: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery. Absence of stomach drainage is not a criterion for judging whether or not gastric suction should be continued.

2. A client with a history of gastric ulcer suddenly complains of a sharp-severe pain in the mid epigastric area, which then spreads over the entire abdomen. The client’s abdomen is rigid and board-like to palpation, and the client obtains most comfort from lying in the knee-chest position. The nurse calls the physician immediately suspecting that the client is experiencing which of the following complications of peptic ulcer disease?

• A. Perforation
• B. Obstruction
• C. Hemorrhage
• D. Intractability

Correct answer: A

Rationale: The signs and symptoms described in the question are consistent with perforation of the ulcer, which then progresses to peritonitis if the perforation is large enough. The client with intestinal obstruction most likely would complain of abdominal pain, distension, and nausea and vomiting. The client with hemorrhage would be vomiting blood or coffee-ground-like material or would be expelling black, tarry, or bloody stools. Intractability is a term that refers to continued symptoms of a disease process, despite ongoing medical treatment.

3. 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.

4. A client who has ulcerative colitis has persistent diarrhea. He is thin and has lost 12 pounds since the exacerbation of his ulcerative colitis. The nurse should anticipate that the physician will order which of the following treatment approaches to help the client meet his nutritional needs?

• A. Initiate continuous enteral feedings
• B. Encourage a high protein, high-calorie diet
• C. Implement total parenteral nutrition
• D. Provide six small meals a day.

Correct answer: C

Rationale: Implementing total parenteral nutrition helps meet the nutritional needs of a client with persistent diarrhea and significant weight loss due to ulcerative colitis.

5. Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy?

• A. Peristalsis.
• B. Gastric acidity.
• C. Gastric motility.
• D. Gastric pH.

Correct answer: D

Rationale: After a gastric vagotomy, the gastric pH increases as a result of reduced acid secretion.

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