the nurse evaluates the clients stoma during the initial post op period which of the following observations should be reported immediately to the phys
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Nursing Elites

ATI RN

ATI Gastrointestinal System Test

1. The nurse evaluates the client’s stoma during the initial post-op period. Which of the following observations should be reported immediately to the physician?

Correct answer: B

Rationale: A dark red to purple stoma may indicate compromised blood flow or ischemia, which requires immediate medical attention. This color change could be a sign of inadequate blood supply to the stoma tissue, leading to tissue damage or necrosis. Reporting this observation promptly is crucial to prevent further complications. Choices A, C, and D are not indicative of immediate medical concern. A slightly edematous stoma, oozing a small amount of blood, or not expelling stool may not be uncommon findings during the initial post-op period and can be managed without urgent intervention.

2. After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery?

Correct answer: A

Rationale: Dark brown drainage is expected for about 12 to 24 hours after surgery.

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

Correct answer: C

Rationale: Coffee-ground emesis indicates that the gastric bleeding occurred 2 hours earlier.

4. Which of the following factors should be the main focus of nursing management for a client hospitalized for cholecystitis?

Correct answer: B

Rationale: Assessment for complications should be the main focus of nursing management for a client hospitalized for cholecystitis.

5. A client is to take one daily dose of ranitidine (Zantac) at home to treat her peptic ulcer. The nurse knows that the client understands proper drug administration of ranitidine when she says that she will take the drug at which of the following times?

Correct answer: C

Rationale: Ranitidine (Zantac) is best taken at bedtime to reduce stomach acid production overnight.

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