Nursing Elites

1. A client is 48 hours postoperative following a small bowel resection. The client reports gas pains in the periumbilical area. The nurse should plan care based on which of the following factors contributing to this postoperative complication?

• A. Impaired peristalsis of the intestines
• B. Infection at the surgical site
• C. Fluid overload
• D. Inadequate pain management

Correct answer: A

Rationale: Gas pains in the periumbilical area postoperatively are often caused by impaired peristalsis and bowel function. Following abdominal surgery, it is common for peristalsis to be reduced due to surgical manipulation and anesthesia effects. This reduction in peristalsis can lead to the accumulation of gas in the intestines, resulting in gas pains. Infection at the surgical site (Choice B) would present with localized signs of infection such as redness, swelling, warmth, and drainage, rather than diffuse gas pains. Fluid overload (Choice C) would manifest with symptoms such as edema, increased blood pressure, and respiratory distress, not gas pains. Inadequate pain management (Choice D) may lead to increased discomfort, but it is not the primary cause of gas pains in the periumbilical area following a small bowel resection.

2. A client reports abdominal pain. An assessment by the nurse reveals a temperature of 39.2 degrees C (102 degrees F), heart rate of 105/min, a soft tender abdomen, and menses overdue by 2 days. Which of the following findings should be the nurse's priority?

• A. Temperature
• B. Heart rate
• C. Abdominal tenderness
• D. Overdue menses

Correct answer: A

Rationale: The nurse's priority should be the client's temperature. A high temperature of 39.2 degrees C (102 degrees F) indicates a potential infection or inflammation that requires immediate attention. While heart rate and abdominal tenderness are important assessments, the temperature takes precedence as it signals a more urgent issue. Overdue menses, although significant, are not the priority in this scenario when compared to the possibility of an acute infection or inflammatory process.

3. The client with chronic obstructive pulmonary disease (COPD) is being educated about lifestyle changes. Which statement by the client indicates a need for further teaching?

• A. I will reduce my salt intake.
• B. I will exercise for 30 minutes most days of the week.
• C. I will drink alcohol only on the weekends.
• D. I will monitor my blood pressure regularly.

Correct answer: C

Rationale: The correct answer is C. Clients with COPD should limit alcohol intake, not just to weekends, to effectively manage their condition. Excessive alcohol consumption can worsen respiratory symptoms and interfere with medications. Choices A, B, and D are all appropriate and beneficial for clients with COPD. Salt intake reduction helps in managing fluid retention and blood pressure. Regular exercise improves lung function and overall health. Monitoring blood pressure is crucial for individuals with COPD as hypertension is a common comorbidity.

4. A nurse offers pain medication to a client who is postoperative before ambulation. The nurse understands that this aspect of care delivery is an example of which of the following ethical principles?

• A. Fidelity
• B. Autonomy
• C. Justice
• D. Beneficence

Correct answer: D

Rationale: The correct answer is D: Beneficence. Beneficence involves actions intended to benefit the client, such as providing pain relief. In this scenario, the nurse is demonstrating beneficence by offering pain medication to alleviate the client's discomfort and promote their well-being. Fidelity (A) relates to being faithful to agreements and commitments, autonomy (B) refers to respecting a client's right to make decisions about their care, and justice (C) involves fairness and equal treatment. While these ethical principles are important in healthcare, the situation described primarily exemplifies the principle of beneficence.

5. A client is expressing anger over his diagnosis of colorectal cancer. Which of the following actions should the nurse take?

• A. Discuss the risk factors for colorectal cancer.
• B. Focus teaching on addressing the client's anger and emotional response.
• C. Provide the client with emotional support and reassurance about his feelings.
• D. Reassure the client that this is an expected response to grief.

Correct answer: D

Rationale: The correct answer is D. During the anger stage of grief, it is essential for the nurse to reassure the client that anger is a normal reaction to a cancer diagnosis. This validation of the client's emotions can help in providing emotional support. Choice A is incorrect because discussing risk factors for colorectal cancer does not address the client's current emotional state. Choice B is incorrect because focusing teaching on the client's future management does not directly address the client's need for emotional support in the present. Choice C is incorrect because providing written information about loss and grief phases is not as immediately comforting as directly reassuring the client about his feelings of anger.

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