Nursing Elites

1. During an abdominal assessment, a nurse finds pulsation between the umbilicus and pubis on a client. What finding should be reported to the physician?

• A. Concave, midline umbilicus
• B. Pulsation between the umbilicus and pubis
• C. Bowel sound frequency of 15 sounds per minute
• D. Absence of a bruit

Correct answer: B

Rationale: The presence of pulsation between the umbilicus and pubis could indicate an abdominal aortic aneurysm, which is a serious condition and should be reported to the physician promptly. A concave, midline umbilicus is a normal finding. Bowel sound frequency can vary widely and is not a cause for concern at 15 sounds per minute. Absence of a bruit is a normal finding in an abdominal assessment and does not require reporting.

2. Of the following signs and symptoms of bowel obstruction, which is related primarily to small bowel obstruction rather than large bowel obstruction?

• A. Profuse vomiting.
• B. Cramping abdominal pain.
• C. Abdominal distention.
• D. High-pitched bowel sounds above the obstruction.

Correct answer: A

Rationale: Profuse vomiting is the classic sign of small bowel obstruction and rarely occurs with large bowel obstruction. Abdominal discomfort and distention are present in both small and large bowel obstructions, but distention is more common in large bowel obstruction. High-pitched bowel sounds indicate hyperperistalsis, which occurs early in obstruction.

3. The client with a colostomy has an order for irrigation of the colostomy. The nurse used which solution for irrigation?

• A. Distilled water
• B. Tap water
• C. Sterile water
• D. Lactated Ringer’s

Correct answer: B

Rationale: Tap water at body temperature is generally used for colostomy irrigation unless the local water supply is not safe for drinking, in which case bottled water can be used.

4. A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following?

• A. Metabolic acidosis with hyperkalemia
• B. Metabolic acidosis with hypokalemia
• C. Metabolic alkalosis with hyperkalemia
• D. Metabolic alkalosis with hypokalemia

Correct answer: D

Rationale: Frequent vomiting can lead to metabolic alkalosis with hypokalemia due to the loss of stomach acid and electrolytes.

5. In a client with Crohn’s disease, which of the following symptoms should not be a direct result from antibiotic therapy?

• A. Decrease in bleeding
• B. Decrease in temperature
• C. Decrease in body weight
• D. Decrease in the number of stools

Correct answer: C

Rationale: Decrease in body weight is not a direct result of antibiotic therapy but may occur due to the underlying disease process.

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