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 pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics?

• A. Early satiety
• B. Pain on eating
• C. Dull upper epigastric pain
• D. Pain on empty stomach

Correct answer: D

Rationale: Pain on an empty stomach is characteristic of a duodenal ulcer, while pain on eating is characteristic of a gastric ulcer.

3. The client with cirrhosis has ascites and excess fluid volume. Which measure will the nurse include in the plan of care for this client?

• A. Increase the amount of sodium in the diet.
• B. Limit the amount of fluids consumed.
• C. Encourage frequent ambulation.
• D. Administer magnesium antacids.

Correct answer: B

Rationale: Excess fluid volume, related to the accumulation of fluid in the peritoneal and dependent areas of the body, can occur in the client with cirrhosis. Fluids should be restricted, including fluids given in medications and meals. Sodium restriction also aids in reducing fluid volume excess.

4. The nurse is preparing a discharge teaching plan for the client who had an umbilical hernia repair. Which of the following would the nurse include in the plan?

• A. Restricting pain medication
• B. Maintaining bedrest
• C. Avoiding coughing
• D. Irrigating the drain

Correct answer: C

Rationale: To prevent strain on the surgical site and avoid disruption of tissue integrity, the client should avoid coughing after an umbilical hernia repair.

5. Which of the following techniques would the nurse use first to determine if a nasogastric tube is positioned in the stomach?

• A. Aspirating with a syringe and observing for the return of gastric contents.
• B. Irrigating with normal saline and observing for the return of solution.
• C. Placing the tube's free end in water and observing for air bubbles.
• D. Instilling air and auscultating over the epigastric area for the presence of the tube.

Correct answer: A

Rationale: The initial way to determine if a nasogastric tube is in the stomach is to apply suction to the tube with a syringe and observe for the return of stomach contents. Then the pH of the aspirate can be measured. This is the method of choice. One would not irrigate until tube placement is confirmed. Observing for air bubbles when the free end of the tube is placed under water is an unacceptable, unsafe method of determining tube placement. Another method is to instill air into the tube with a syringe while auscultating over the epigastric area. Hearing the air enter the stomach helps ensure proper placement, but the method is not foolproof and is no longer considered an effective or preferred way to determine placement.

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