Nursing Elites

1. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?

• A. He has fresh, active upper GI bleeding.
• B. He needs immediate saline gastric lavage.
• C. His gastric bleeding occurred 2 hours earlier.
• D. He needs a transfusion of packed RBCs.

Correct answer: C

Rationale: Coffee-ground emesis is a sign of upper gastrointestinal bleeding that occurred approximately 2 hours earlier. It results from the breakdown of blood in the stomach due to digestive enzymes, giving it a coffee-ground appearance. Choice A is incorrect because coffee-ground emesis indicates older, partially digested blood, not fresh active bleeding. Choice B is incorrect as gastric lavage is not indicated for coffee-ground emesis. Choice D is incorrect because a transfusion of packed RBCs is not the immediate management for this presentation.

2. When assessing the client with celiac disease, the nurse can expect to find which of the following?

• A. Steatorrhea
• B. Jaundiced sclerae
• C. Clay-colored stools
• D. Widened pulse pressure

Correct answer: A

Rationale: Because celiac disease destroys the absorbing surface of the intestine, fat isn't absorbed but is passed in the stool. Steatorrhea is bulky, fatty stools that have a foul odor. Jaundiced sclerae result from elevated bilirubin levels. Clay-colored stools are seen with biliary disease when bile flow is blocked. Celiac disease doesn't cause a widened pulse pressure.

3. The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions?

• A. Supine with the head of the bed flat
• B. On the stomach with the head flat
• C. On the left side with the head of the bed elevated 30 degrees
• D. On the right side with the head of the bed elevated 30 degrees.

Correct answer: C

Rationale: Lying on the left side with the head of the bed elevated 30 degrees helps prevent reflux by keeping stomach contents from moving up into the esophagus.

4. Which of the following measures should the nurse focus on for the client with esophageal varices?

• A. Recognizing hemorrhage
• B. Controlling blood pressure
• C. Encouraging nutritional intake
• D. Teaching the client about varices

Correct answer: A

Rationale: The primary focus for a client with esophageal varices is recognizing hemorrhage because these varices can rupture and cause significant bleeding.

5. The nurse instructs the ileostomy client to do which of the following as a part of essential care of the stoma?

• A. Cleanse the peristomal skin meticulously
• B. Take in high-fiber foods such as nuts
• C. Massage the area below the stoma
• D. Limit fluid intake to prevent diarrhea.

Correct answer: A

Rationale: Cleansing the peristomal skin meticulously is crucial to prevent irritation and infection around the stoma.

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