Nursing Elites

1. A client is scheduled for an abdominal perineal resection with permanent colostomy. Which of the following measures would most likely be included in the plan for the client's preoperative preparation?

• A. Keep the client NPO for 2 days before surgery.
• B. Administer kanamycin (Kantrex) the night before surgery.
• C. Inform the client that chest tubes will be in place after surgery.
• D. Advise the client to limit activity.

Correct answer: B

Rationale: Antibiotics are administered preoperatively to reduce the bacterial count in the colon. The client will be placed on a low residue diet to help cleanse the bowel before surgery but typically is not placed on NPO status until 8 to 12 hours before surgery. Laxatives and enemas may also be administered. Chest tubes would not be expected postoperatively. There is no need to limit the client's activity before surgery.

2. The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome?

• A. Eat high-carbohydrate foods
• B. Limit the fluids taken with meals
• C. Ambulate following a meal
• D. Sit in a high-Fowlers position during meals

Correct answer: B

Rationale: To prevent dumping syndrome after a gastrectomy, it is recommended to limit fluids taken with meals to slow down gastric emptying and reduce the symptoms.

3. Mucosal barrier fortifiers are used in peptic ulcer disease management for which of the following indications?

• A. To inhibit mucus production
• B. To neutralize acid production
• C. To stimulate mucus production
• D. To stimulate hydrogen ion diffusion back into the mucosa

Correct answer: C

Rationale: Mucosal barrier fortifiers stimulate mucus production, which helps protect the lining of the stomach and manage peptic ulcer disease.

4. A client has been diagnosed with gastroesophageal reflux disease. The nurse interprets that the client has dysfunction of which of the following parts of the digestive system?

• A. Chief cells of the stomach
• B. Parietal cells of the stomach
• C. Lower esophageal sphincter
• D. Upper esophageal sphincter

Correct answer: C

Rationale: The lower esophageal sphincter is a functional sphincter that normally remains closed except when food or fluids are swallowed. If relaxation of this sphincter occurs, the client could experience symptoms of gastroesophageal reflux disease.

5. The nurse is caring for a client with an exacerbation of ulcerative colitis. Which of the following nursing measures should be included in the client's plan of care?

• A. Encourage regular use of antidiarrheal medications.
• B. Incorporate frequent rest periods into the client's schedule.
• C. Have the client maintain a high-fiber diet.
• D. Wear a gown when providing direct client care.

Correct answer: B

Rationale: It is important for the client to have frequent rest periods. Repeated episodes of diarrhea interrupt sleep patterns, and poor nutrition may also cause the client to feel weak. If the client is experiencing a severe exacerbation of ulcerative colitis, bed rest may be ordered. Antidiarrheal medications can be used selectively in ulcerative colitis but are not recommended for regular use as they can lead to colonic dilation. The client should maintain a low-residue, high-calorie, caffeine-free diet.

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