the nurse develops a plan of care for a client with a t tube which one of the following nursing interventions should be included
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Nursing Elites

ATI RN

ATI Gastrointestinal System

1. The nurse develops a plan of care for a client with a T tube. Which one of the following nursing interventions should be included?

Correct answer: A

Rationale: The correct nursing intervention to include in the plan of care for a client with a T tube is to inspect the skin around the T tube daily for irritation. Bile is erosive and can cause skin irritation, so it is crucial to keep the skin clean and dry. T tubes are not routinely irrigated; irrigation is done only with a physician's order. It is unnecessary to maintain the client in a supine position; instead, assist the client into a position of comfort. T tubes are not typically clamped unless ordered by a physician, and if clamped, it is usually done 1 to 2 hours before and after meals.

2. Which of the following medications is most effective for treating the pain associated with irritable bowel disease?

Correct answer: A

Rationale: Acetaminophen is often the first line of treatment for pain associated with irritable bowel disease due to its safety profile.

3. Glenda has cholelithiasis (gallstones). You expect her to complain of:

Correct answer: A

Rationale: Patients with cholelithiasis often complain of pain in the right upper quadrant, radiating to the shoulder.

4. The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient’s diet?

Correct answer: A

Rationale: For a patient with liver failure, it is important to limit the intake of meats and beans to reduce the risk of hepatic encephalopathy.

5. After an abdominal resection for colon cancer, Madeline returns to her room with a Jackson-Pratt drain in place. The purpose of the drain is to:

Correct answer: D

Rationale: The purpose of the Jackson-Pratt drain is to prevent the accumulation of drainage in the wound after an abdominal resection.

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