Nursing Elites

1. A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:

• A. Absence of nausea and vomiting.
• B. Passage of mucus from the rectum.
• C. Passage of flatus and feces from the colostomy.
• D. Absence of stomach drainage for 24 hours.

Correct answer: C

Rationale: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery. Absence of stomach drainage is not a criterion for judging whether or not gastric suction should be continued.

2. 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.

3. A client with peptic ulcer is scheduled for a Vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure

• A. Decreases food absorption in the stomach.
• B. Heals the gastric mucosa.
• C. Halts stress reactions.
• D. Reduces the stimulus to acid secretions.

Correct answer: D

Rationale: A vagotomy, or cutting of the vagus nerve, is done to eliminate parasympathetic stimulation of gastric secretion, thereby reducing the stimulus to acid secretions. Options A, B, and C are incorrect as a vagotomy does not affect food absorption, heal the gastric mucosa, or halt stress reactions.

4. The client has had a new colostomy created 2 days earlier. The client is beginning to pass malodorous flatus from the stoma. The nurse interprets that

• A. This indicates inadequate preoperative bowel preparation.
• B. This is a normal, expected event.
• C. The client is experiencing early signs of ischemic bowel.
• D. The client should not have the nasogastric tube removed.

Correct answer: B

Rationale: As peristalsis returns following creation of a colostomy, the client begins to pass malodorous flatus. This indicates returning bowel function and is an expected event. Within 72 hours of surgery, the client should begin passing stool via the colostomy.

5. Which of the following substances is most likely to cause gastritis?

• A. Milk
• B. Bicarbonate of soda or baking soda
• C. Enteric-coated aspirin
• D. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Correct answer: D

Rationale: The correct answer is D, Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are known to cause gastritis by irritating the stomach lining. Choice A, Milk, is unlikely to cause gastritis and is actually a common remedy for mild gastritis symptoms. Choice B, Bicarbonate of soda or baking soda, is often used to relieve heartburn and indigestion, not cause gastritis. Choice C, Enteric-coated aspirin, is less likely to cause gastritis compared to NSAIDs because the enteric coating helps protect the stomach lining from irritation.

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