Nursing Elites

1. The nurse is reviewing the physician’s orders written for a client admitted with acute pancreatitis. Which physician order would the nurse question if noted on the client’s chart?

• A. NPO status
• B. Insert a nasogastric tube
• C. An anticholinergic medication
• D. Morphine for pain

Correct answer: D

Rationale: Morphine for pain should be questioned as it can cause spasms of the sphincter of Oddi, worsening pancreatitis.

2. Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes:

• A. Continuous peritoneal lavage.
• B. Regular diet with increased fat.
• C. Nutritional support with TPN.
• D. Insertion of a T tube to drain the pancreas.

Correct answer: C

Rationale: Treatment for acute pancreatitis includes nutritional support with TPN.

3. To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine which body areas?

• A. Nail beds
• B. Skin on the back of the hand
• C. Hard palate of the mouth
• D. Soles of the feet

Correct answer: C

Rationale: To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine the hard palate of the mouth. Jaundice is best assessed in the sclera; however, in dark-skinned patients, normal yellow pigmentation may be present in the sclera, making it difficult to detect jaundice. Inspection of the hard palate for a yellow color can confirm the presence of jaundice. Cyanosis is best observed in the nail beds, not indicative of jaundice. While skin on the palm of the hand can indicate jaundice, the back of the hand is not a typical area for assessment. Jaundice can be assessed on the soles of the feet in dark-skinned patients, but it is better visualized in the hard palate for accurate evaluation.

4. 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.

5. Which of the following expected outcomes would be appropriate for the client who has ulcerative colitis?

• A. The client maintains a daily record of intake and output.
• B. The client verbalizes the importance of small, frequent feedings.
• C. The client uses a heating pad to decrease abdominal cramping.
• D. The client accepts that a colostomy is inevitable at some time in his life.

Correct answer: B

Rationale: Small, frequent feedings are better tolerated by clients with ulcerative colitis as they lessen the amount of fecal material present in the gastrointestinal tract and decrease stimulation. The client does not need to maintain a daily record of intake and output unless an exacerbation of the disease occurs. A heating pad should not be applied to the intestine as it is inflamed. It is not inevitable that the client will require surgery to treat ulcerative colitis.

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