Nursing Elites

1. A client who has had gastrectomy is not producing sufficient intrinsic factor. The nurse interprets that the client has lost the ability to absorb cyanocobalamin (vitamin B12) in the

• A. Stomach.
• B. Small intestine.
• C. Large intestine.
• D. Colon.

Correct answer: B

Rationale: Intrinsic factor is produced in the stomach but is used to aid in the absorption of vitamin B12 in the small intestine. Vitamin B12 is not absorbed in the large intestine (options 3 and 4).

2. A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric area along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following?

• A. An intestinal obstruction has developed
• B. Additional ulcers have developed
• C. The esophagus has become inflamed
• D. The ulcer has perforated

Correct answer: D

Rationale: A sudden, sharp pain in the midepigastric area along with a rigid, boardlike abdomen indicates that the ulcer has perforated.

3. A client is admitted to the hospital with acute viral hepatitis. Which of the following signs or symptoms would the nurse expect to note based on this diagnosis?

• A. Spider angiomas
• B. Fatigue
• C. Pale urine
• D. Weight gain

Correct answer: B

Rationale: Common signs of acute viral hepatitis include weight loss, dark urine, and fatigue. The client is anorexic, possibly from a toxin produced by the diseased liver, and finds food distasteful. The urine darkens because of excess bilirubin being excreted by the kidneys. Fatigue occurs during all phases of hepatitis.

4. A nurse teaches a preoperative client about the nasogastric tube that will be inserted in preparation for surgery. The nurse determines that the client understands when the tube will be removed in the postoperative period when the client states

• A. When my gastrointestinal system is healed enough.
• B. When I can tolerate food without vomiting.
• C. When my bowels begin to function again, and I begin to pass gas.
• D. When the doctor says so.

Correct answer: C

Rationale: Nasogastric tubes are discontinued when normal function returns to the gastrointestinal tract. The tube will be removed before gastrointestinal healing. Food would not be administered unless bowel function returns. Although the physician determines when the nasogastric tube will be removed, option 4 does not determine effectiveness of teaching.

5. Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease?

• A. Calcium carbonate (Tums)
• B. Famotidine (Pepcid)
• C. Misoprostol (Cytotec)
• D. Sucralfate (Carafate)

Correct answer: C

Rationale: Misoprostol (Cytotec) is useful in preventing NSAID-induced peptic ulcer disease.

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