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 healthcare professional is caring for a group of clients on a medical-surgical unit. Which of the following clients is at increased risk for body-image disturbances?

• A. A client who had a laparoscopic appendectomy
• B. A client who had a mastectomy
• C. A client who had a left above-the-knee amputation
• D. A client who had a cardiac catheterization

Correct answer: C

Rationale: Clients who have undergone significant visible body changes, like amputation, are at increased risk for body-image disturbances. Amputation can have a profound impact on self-image and body perception due to the visible structural alteration. While conditions like laparoscopic appendectomy, mastectomy, and cardiac catheterization may also affect body image, they are less likely to cause significant disturbances compared to visible changes like amputation.

3. A client with a new colostomy is being taught how to irrigate the ostomy. The healthcare provider realizes that the client needs further teaching when the client:

• A. Positions the irrigating solution bag 30 inches below the stoma
• B. Uses an open system for irrigation
• C. Irrigates the colostomy twice a day
• D. Cleans the stoma with harsh chemicals

Correct answer: A

Rationale: The correct answer is A. Positioning the irrigating solution bag 30 inches below the stoma would cause discomfort and ineffective irrigation as the bag should be positioned at a lower level. Option B is incorrect because a closed system for irrigation is the preferred method for colostomy irrigation. Option C is incorrect as colostomy irrigation is typically done once a day unless otherwise instructed by a healthcare provider. Option D is incorrect as the stoma should be cleaned with mild soap and water to prevent skin irritation and damage.

4. The patient is receiving chemotherapy for breast cancer. Which of the following laboratory values would be most important to monitor?

• A. White blood cell count
• B. Hemoglobin level
• C. Serum creatinine
• D. Blood glucose level

Correct answer: A

Rationale: Monitoring the white blood cell count is crucial when a patient is undergoing chemotherapy for breast cancer. Chemotherapy can lead to neutropenia, a condition of low white blood cell count, which significantly increases the risk of infections. Monitoring white blood cell count helps healthcare providers intervene promptly to prevent severe infections. Hemoglobin level, while important in assessing oxygen-carrying capacity, is not the priority in this scenario. Serum creatinine and blood glucose levels are not directly impacted by chemotherapy for breast cancer.

5. During passive range of motion (ROM) and splinting, the absence of which finding will indicate goal achievement for these interventions?

• A. Atelectasis
• B. Renal calculi
• C. Pressure ulcers
• D. Joint contractures

Correct answer: D

Rationale: The correct answer is D: Joint contractures. When a healthcare provider performs passive ROM and splinting on a patient, the goal is to prevent joint contractures. Joint contractures result from immobility and can lead to permanent stiffness and decreased range of motion. Atelectasis (choice A) is a condition where there is a complete or partial collapse of the lung, commonly due to immobility, but not directly related to passive ROM or splinting. Renal calculi (choice B) are kidney stones and are not typically associated with ROM exercises. Pressure ulcers (choice C) result from prolonged pressure on the skin and are prevented by repositioning the patient, not specifically addressed by ROM and splinting exercises.

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