Nursing Elites

1. Which of the following techniques would the nurse use first to determine if a nasogastric tube is positioned in the stomach?

• A. Aspirating with a syringe and observing for the return of gastric contents.
• B. Irrigating with normal saline and observing for the return of solution.
• C. Placing the tube's free end in water and observing for air bubbles.
• D. Instilling air and auscultating over the epigastric area for the presence of the tube.

Correct answer: A

Rationale: The initial way to determine if a nasogastric tube is in the stomach is to apply suction to the tube with a syringe and observe for the return of stomach contents. Then the pH of the aspirate can be measured. This is the method of choice. One would not irrigate until tube placement is confirmed. Observing for air bubbles when the free end of the tube is placed under water is an unacceptable, unsafe method of determining tube placement. Another method is to instill air into the tube with a syringe while auscultating over the epigastric area. Hearing the air enter the stomach helps ensure proper placement, but the method is not foolproof and is no longer considered an effective or preferred way to determine placement.

2. A nurse is providing the client with biliary obstruction a simple overview of the anatomy of the liver and gallbladder. The nurse tells the client that normally the liver stores bile in the gallbladder, which is connected to the liver by the?

• A. Liver canaliculi
• B. Common bile duct
• C. Cystic duct
• D. Right hepatic duct.

Correct answer: C

Rationale: The gallbladder receives bile from the liver through the cystic duct. The liver collects bile in the canaliculi. Bile then flows into the common hepatic duct. From the common hepatic duct, the bile can be stored in the gallbladder through the cystic duct. Otherwise, the bile can flow directly into the duodenum by way of the common bile duct.

3. Which of the following complications is thought to be the most common cause of appendicitis?

• A. A fecalith
• B. Bowel kinking
• C. Internal bowel occlusion
• D. Abdominal bowel swelling

Correct answer: A

Rationale: A fecalith is a hardened stool that can block the appendix, leading to inflammation and infection, which is the most common cause of appendicitis.

4. You’re caring for Jane, a 57 y.o. patient with liver cirrhosis who develops ascites and requires paracentesis. Before her paracentesis, you instruct her to:

• A. Empty her bladder.
• B. Lie supine in bed.
• C. Remain NPO for 4 hours.
• D. Clean her bowels with an enema.

Correct answer: A

Rationale: Before paracentesis, instruct the patient to empty her bladder to avoid bladder injury during the procedure.

5. Which of the following nursing interventions should be implemented to manage a client with appendicitis?

• A. Assessing for pain
• B. Encouraging oral intake of clear fluids
• C. Providing discharge teaching
• D. Assessing for symptoms of peritonitis

Correct answer: D

Rationale: The correct answer is D: Assessing for symptoms of peritonitis. This intervention is crucial in managing a client with appendicitis because it indicates a possible rupture of the inflamed appendix. Symptoms of peritonitis include severe abdominal pain, fever, nausea, vomiting, and abdominal rigidity. Prompt recognition of these symptoms is essential for timely intervention and surgical management. Choices A, B, and C are incorrect because while assessing for pain is important, assessing for symptoms of peritonitis takes precedence due to the critical nature of appendicitis. Encouraging oral intake of clear fluids and providing discharge teaching are not immediate priorities in the management of a client with acute appendicitis.

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