Nursing Elites

1. A nurse is inserting a nasogastric tube in an adult client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the most appropriate nursing action?

• A. Remove the tube and reinsert when the respiratory distress subsides.
• B. Pull back on the tube and wait until the respiratory distress subsides.
• C. Quickly insert the tube.
• D. Notify the physician immediately.

Correct answer: B

Rationale: During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tube advancement, and wait until the distress subsides. Options 1 and 4 are unnecessary. Quickly inserting the tube is not an appropriate action because, in this situation, it may be likely that the tube has entered the bronchus.

2. George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage?

• A. If there is any drainage, notify the surgeon immediately.
• B. The drainage will decrease daily until the bile duct heals.
• C. First, the drainage is dark green; then it becomes dark yellow.
• D. If the drainage stops, milk the tube toward the puncture wound.

Correct answer: B

Rationale: Before discharge, inform the patient that the drainage will decrease daily until the bile duct heals.

3. Michael, a 42 y.o. man is admitted to the med-surg floor with a diagnosis of acute pancreatitis. His BP is 136/76, pulse 96, Resps 22 and temp 101. His past history includes hyperlipidemia and alcohol abuse. The doctor prescribes an NG tube. Before inserting the tube, you explain the purpose to patient. Which of the following is a most accurate explanation?

• A. It empties the stomach of fluids and gas.
• B. It prevents spasms at the sphincter of Oddi.
• C. It prevents air from forming in the small intestine and large intestine.
• D. It removes bile from the gallbladder.

Correct answer: A

Rationale: Explain to the patient that the NG tube is used to empty the stomach of fluids and gas, which helps relieve symptoms of acute pancreatitis.

4. A 30-year old client experiences weight loss, abdominal distention, crampy abdominal pain, and intermittent diarrhea after the birth of her 2nd child. Diagnostic tests reveal gluten-induced enteropathy. Which foods must she eliminate from her diet permanently?

• A. Milk and dairy products
• B. Protein-containing foods
• C. Cereal grains (except rice and corn)
• D. Carbohydrates

Correct answer: C

Rationale: Gluten-induced enteropathy, or celiac disease, requires the elimination of gluten-containing grains like wheat, barley, and rye. Dairy, proteins, and carbohydrates are not excluded unless the client has specific intolerances.

5. The nurse is caring for a client with an exacerbation of ulcerative colitis. Which of the following nursing measures should be included in the client's plan of care?

• A. Encourage regular use of antidiarrheal medications.
• B. Incorporate frequent rest periods into the client's schedule.
• C. Have the client maintain a high-fiber diet.
• D. Wear a gown when providing direct client care.

Correct answer: B

Rationale: It is important for the client to have frequent rest periods. Repeated episodes of diarrhea interrupt sleep patterns, and poor nutrition may also cause the client to feel weak. If the client is experiencing a severe exacerbation of ulcerative colitis, bed rest may be ordered. Antidiarrheal medications can be used selectively in ulcerative colitis but are not recommended for regular use as they can lead to colonic dilation. The client should maintain a low-residue, high-calorie, caffeine-free diet.

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