Nursing Elites

1. You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority?

• A. Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.
• B. Obtain vital signs, call the doctor, and obtain emergency orders.
• C. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees.
• D. Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.

Correct answer: D

Rationale: For a patient with a ruptured wound and protruding bowel, call the doctor while remaining with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.

2. Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity?

• A. Restrict fluids
• B. Encourage ambulation
• C. Increase sodium in the diet
• D. Give antacids as prescribed

Correct answer: A

Rationale: Restricting fluids is necessary to decrease the excessive accumulation of serous fluid in the peritoneal cavity for a patient with ascites due to cirrhosis.

3. The nurse has inserted a nasogastric tube to the level of the oropharynx and has repositioned the client’s head in a flexed-forward position. The client has been asked to begin swallowing. The nurse starts slowly to advance the nasogastric tube with each swallow. The client begins to cough, gag, and choke. Which nursing action would least likely result in proper tube insertion and promote client relaxation?

• A. Continuing to advance the tube to the desired distance
• B. Pulling the tube back slightly
• C. Checking the back of the pharynx using a tongue blade and flashlight.
• D. Instructing the client to breathe slowly and take sips of water.

Correct answer: A

Rationale: As the nasogastric tube is passed through the oropharynx, the gag reflex is stimulated, which may cause coughing, gagging, or choking. Instead of passing through to the esophagus, the nasogastric tube may coil around itself in the oropharynx, or it may enter the larynx and obstruct the airway, pulling the tube back slightly will remove it from the larynx; advancing the tube might position it in the trachea. Swallowing closes the epiglottis over the trachea and helps move the tube into the esophagus. Slow breathing helps the client relax to reduce the gag response. The nurse should check the back of the client’s throat to note if the tube has coiled. The tube may be advanced after the client relaxes.

4. A client with gastric cancer can expect to have surgery for resection. Which of the following should be the nursing management priority for the preoperative client with gastric cancer?

• A. Discharge planning
• B. Correction of nutritional deficits
• C. Prevention of DVT
• D. Instruction regarding radiation treatment

Correct answer: B

Rationale: The priority for preoperative management of a client with gastric cancer is the correction of nutritional deficits.

5. Which of the following activities should the nurse encourage the client with a peptic ulcer to avoid?

• A. Chewing gum.
• B. Smoking cigarettes.
• C. Eating chocolate.
• D. Taking acetaminophen (Tylenol).

Correct answer: B

Rationale: Cigarette smoking should be avoided because of its stimulatory effect on gastric secretions. Nicotine also increases the release of epinephrine, which leads to vasoconstriction. The client may chew gum if desired. The client may eat chocolate if desired. A client with a peptic ulcer should check with the physician before taking any over-the-counter drug, but acetaminophen does not typically cause gastric irritation.

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