Nursing Elites

1. A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During pre-operative teaching, the nurse is reinforcing information about the procedure. Which of the following explanations is most accurate?

• A. The procedure will result in enlargement of the pyloric sphincter
• B. The procedure will result in anastomosis of the gastric stump to the jejunum
• C. The procedure will result in removal of the duodenum
• D. The procedure will result in repositioning of the vagus nerve

Correct answer: B

Rationale: The Billroth II procedure involves anastomosis of the gastric stump to the jejunum.

2. A nurse is developing a teaching plan for the client with viral hepatitis. The nurse plans to tell the client which of the following in the teaching session?

• A. Activity should be limited to prevent fatigue
• B. The diet should be low in calories
• C. Meals should be large to conserve energy
• D. Alcohol intake should be limited to 2 oz. per day.

Correct answer: A

Rationale: The client with viral hepatitis should limit activity to avoid fatigue during the recuperation period. The diet should be optimal in calories, proteins, and carbohydrates. The client should take in several small meals per day. Alcohol is strictly forbidden.

3. Which of the following definitions best describes gastritis?

• A. Erosion of the gastric mucosa
• B. Inflammation of a diverticulum
• C. Inflammation of the gastric mucosa
• D. Reflux of stomach acid into the esophagus

Correct answer: C

Rationale: The correct answer is C: 'Inflammation of the gastric mucosa.' Gastritis is characterized by inflammation of the stomach lining, specifically the gastric mucosa. This inflammation can be caused by various factors such as infections, medications, alcohol, or autoimmune diseases. Choice A, 'Erosion of the gastric mucosa,' is incorrect because erosion refers to the wearing away of tissue rather than inflammation. Choice B, 'Inflammation of a diverticulum,' is incorrect because gastritis specifically involves inflammation of the stomach lining, not a diverticulum. Choice D, 'Reflux of stomach acid into the esophagus,' describes gastroesophageal reflux disease (GERD), which is different from gastritis.

4. The nurse is reviewing the record of a client with Crohn’s disease. Which of the following stool characteristics would the nurse expect to note documented on the client’s record?

• A. Chronic constipation
• B. Diarrhea
• C. Constipation alternating with diarrhea
• D. Stool constantly oozing from the rectum

Correct answer: B

Rationale: Diarrhea is a common stool characteristic in clients with Crohn’s disease due to inflammation of the gastrointestinal tract.

5. The nurse aspirates 40 mL of undigested formula from the client’s nasogastric tube. Before administering an intermittent tube feeding, the nurse understands that the 40 mL of gastric aspirate should be

• A. Discarded properly and recorded as output on the client’s intake and output record.
• B. Poured into the nasogastric tube through a syringe with the plunger removed.
• C. Mixed with the formula and poured into the nasogastric tube through a syringe with the plunger removed.
• D. Diluted with water and injected into the nasogastric tube by putting pressure on the plunger.

Correct answer: B

Rationale: After checking the residual feeding contents, the gastric contents are reinstalled into the stomach by removing the syringe bulb or plunger and pouring the gastric contents into the syringe and through the nasogastric tube. Gastric contents should be reinstalled to maintain the client’s electrolyte balance. The gastric contents should be poured into the nasogastric tube through a syringe without a plunger and not injected by putting pressure on the plunger. Gastric contents do not need to be mixed with water or should the contents be discarded.

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