Nursing Elites

1. You’re preparing a patient with a malignant tumor for colorectal surgery and subsequent colostomy. The patient tells you he’s anxious. What should your initial step be in working with this patient?

• A. Determine what the patient already knows about colostomies.
• B. Show the patient some pictures of colostomies.
• C. Arrange for someone who has a colostomy to visit the patient.
• D. Provide the patient with written material about colostomy care.

Correct answer: A

Rationale: When a patient with a malignant tumor is anxious about colorectal surgery and a colostomy, the initial step is to determine what the patient already knows about colostomies.

2. The nurse provides discharge instructions to a patient with hepatitis B. Which of the following statements, if made by the patient, would indicate the need for further instruction?

• A. I can never donate blood.
• B. I can never have unprotected sex.
• C. I cannot share needles.
• D. I should avoid drugs and alcohol.

Correct answer: D

Rationale: The correct answer is D. This patient statement indicates a need for further teaching. The patient should be instructed that, in order to avoid complications, alcohol should be avoided for six months to one year. Illicit drugs and toxic chemicals should also be avoided. Acetaminophen may be taken only when necessary and not beyond the recommended dosage. Choices A, B, and C are correct statements regarding precautions to prevent the spread of hepatitis B and do not indicate a need for further instruction.

3. A 53 y.o. patient has undergone a partial gastrectomy for adenocarcinoma of the stomach. An NG tube is in place and is connected to low continuous suction. During the immediate postoperative period, you expect the gastric secretions to be which color?

• A. Brown.
• B. Clear.
• C. Red.
• D. Yellow.

Correct answer: C

Rationale: During the immediate postoperative period after a partial gastrectomy, gastric secretions are expected to be red.

4. A nurse is caring for a client who has just returned from the operating room following the creation of a colostomy. The nurse is assessing the drainage in the pouch attached to the site where the colostomy was formed and notes serosanguineous drainage. Which nursing action is most appropriate based on this assessment?

• A. Notify the physician
• B. Document the amount and characteristics of the drainage
• C. Apply ice to the stoma site
• D. Apply pressure to the site

Correct answer: B

Rationale: During the first 24 to 72 hours following surgery, mucus and serosanguineous drainage are expected from the stoma. Documenting the amount and characteristics of the drainage is appropriate. The nurse does not need to notify the physician because this is an expected finding. Applying ice or pressure to the site is not necessary.

5. When assessing the client with celiac disease, the nurse can expect to find which of the following?

• A. Steatorrhea
• B. Jaundiced sclerae
• C. Clay-colored stools
• D. Widened pulse pressure

Correct answer: A

Rationale: Because celiac disease destroys the absorbing surface of the intestine, fat isn't absorbed but is passed in the stool. Steatorrhea is bulky, fatty stools that have a foul odor. Jaundiced sclerae result from elevated bilirubin levels. Clay-colored stools are seen with biliary disease when bile flow is blocked. Celiac disease doesn't cause a widened pulse pressure.

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