Nursing Elites

1. A client is scheduled for oral cholecystography. Which one of the following actions would the nurse plan to implement before the test?

• A. Have the client drink 1000 mL of water.
• B. Ask the client about possible allergies to iodine or shellfish.
• C. Administer an intravenous contrast agent the evening before the test.
• D. Administer tap-water enemas until clear.

Correct answer: B

Rationale: Iodine compounds used as radiographic contrast agents, such as iopanoic acid (Telepaque), should not be administered to the client with iodine and seafood allergies because anaphylaxis may occur.

2. To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine which body areas?

• A. Nail beds
• B. Skin on the back of the hand
• C. Hard palate of the mouth
• D. Soles of the feet

Correct answer: C

Rationale: To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine the hard palate of the mouth. Jaundice is best assessed in the sclera; however, in dark-skinned patients, normal yellow pigmentation may be present in the sclera, making it difficult to detect jaundice. Inspection of the hard palate for a yellow color can confirm the presence of jaundice. Cyanosis is best observed in the nail beds, not indicative of jaundice. While skin on the palm of the hand can indicate jaundice, the back of the hand is not a typical area for assessment. Jaundice can be assessed on the soles of the feet in dark-skinned patients, but it is better visualized in the hard palate for accurate evaluation.

3. The client has had a new colostomy created 2 days earlier. The client is beginning to pass malodorous flatus from the stoma. The nurse interprets that

• A. This indicates inadequate preoperative bowel preparation.
• B. This is a normal, expected event.
• C. The client is experiencing early signs of ischemic bowel.
• D. The client should not have the nasogastric tube removed.

Correct answer: B

Rationale: As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy.

4. Which of the following therapies is not included in the medical management of a client with peritonitis?

• A. Broad-spectrum antibiotics
• B. Electrolyte replacement
• C. I.V. fluids
• D. Regular diet

Correct answer: D

Rationale: A regular diet is not included in the medical management of peritonitis, which requires bowel rest and IV fluids.

5. The nurse is reviewing the record of a client with Crohn’s disease. Which of the following stool characteristics would the nurse expect to note documented on the client’s record?

• A. Chronic constipation
• B. Diarrhea
• C. Constipation alternating with diarrhea
• D. Stool constantly oozing from the rectum

Correct answer: B

Rationale: Diarrhea is a common stool characteristic in clients with Crohn’s disease due to inflammation of the gastrointestinal tract.

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