Nursing Elites

1. A client is taking an antacid for treatment of a peptic ulcer. Which of the following statements best indicates that the client understands how to correctly take the antacid?

• A. I should take my antacid before I take my other medications.
• B. I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.
• C. My antacid will be most effective if I take it whenever I experience stomach pains.
• D. It is best for me to take my antacid 1 to 3 hours after meals.

Correct answer: D

Rationale: It is best for the client to take the antacid 1 to 3 hours after meals to ensure effectiveness.

2. A nurse orientee is preparing to insert a nasogastric tube, and a nurse educator is observing the procedure. Which of the following supplies if obtained by the nurse orientee would indicate a need for further education regarding this procedure?

• A. Half-inch or one-inch tape
• B. Oil-soluble lubricant
• C. A glass of tap water with a straw
• D. A 50-mL catheter tip syringe

Correct answer: B

Rationale: Water-soluble lubricant is used to lubricate 3 to 4 inches of the tube at the insertion end. An oil lubricant is not used because if the tube accidentally goes into the bronchus, pneumonia can develop. Half-inch tape is used to secure the tube after the correct placement is verified. A 50-mL catheter tip syringe is used to aspirate gastric contents to confirm placement. The client will be asked to take a sip of water through a straw to help with the passage of the tube.

3. The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify?

• A. Irrigating the nasogastric tube
• B. Coughing a deep breathing exercises
• C. Leg exercises
• D. Early ambulation

Correct answer: A

Rationale: Irrigating the nasogastric tube is typically not recommended after a Billroth II procedure unless specifically ordered by a physician due to the risk of disrupting the surgical site.

4. 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.

5. What information is correct about stomach cancer?

• A. Stomach pain is often a late symptom.
• B. Surgery is often a successful treatment.
• C. Chemotherapy and radiation are often successful treatments.
• D. The patient can survive for an extended time with TPN.

Correct answer: A

Rationale: Stomach pain is often a late symptom of stomach cancer.

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