Nursing Elites

1. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery for 2 hours. The client begins to complain of increases abdominal pain and begins to vomit. On assessment the nurse notes that the abdomen distended and bowel sounds are diminished. Which of the following is the most appropriate nursing intervention?

• A. Administer the prescribed pain medication.
• B. Notify the physician.
• C. Call and ask the operating room team to perform the surgery as soon as possible.
• D. Reposition the client and apply a heating pad on warm setting to the client’s abdomen.

Correct answer: B

Rationale: Based on the signs and symptoms presented in the question, the nurse should suspect peritonitis and should notify the physician. Administering pain medication is not an appropriate intervention. Heat should never be applied to the abdomen of a client with suspected appendicitis. Scheduling surgical time is not within the scope of nursing practice, although the physician probably would perform the surgery earlier than the prescheduled time.

2. To prevent gastroesophageal reflux in a client with hiatal hernia, the nurse should provide which discharge instructions?

• A. Lie down after meals to promote digestion.
• B. Avoid coffee and alcoholic beverages.
• C. Take antacids before meals.
• D. Limit fluids with meals.

Correct answer: B

Rationale: To prevent reflux of stomach acid into the esophagus, the nurse should advise the client to avoid foods and beverages that tend to increase stomach acid, such as coffee and alcohol. The nurse also should teach the client to avoid lying down after meals, which can aggravate reflux, and to take antacids after eating. The client doesn't need to limit fluids with meals as long as the fluids aren't gastric irritants.

3. The most important pathophysiologic factor contributing to the formation of esophageal varices is:

• A. Decreased prothrombin formation
• B. Decreased albumin formation by the liver
• C. Portal hypertension
• D. Increased central venous pressure

Correct answer: C

Rationale: Portal hypertension is the most important pathophysiologic factor contributing to the formation of esophageal varices.

4. The pain of a duodenal ulcer can be distinguished from that of a gastric ulcer by which of the following characteristics?

• A. Early satiety
• B. Pain on eating
• C. Dull upper epigastric pain
• D. Pain on empty stomach

Correct answer: D

Rationale: Pain on an empty stomach is characteristic of a duodenal ulcer, while pain on eating is characteristic of a gastric ulcer.

5. When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important?

• A. Eat a low-protein diet
• B. Eat a low-fat, low-cholesterol diet
• C. Limit exercise to 10 minutes/day
• D. Keep weight proportionate to height

Correct answer: B

Rationale: Eating a low-fat, low-cholesterol diet is most important for preventing cholecystitis.

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