Nursing Elites

1. A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following?

• A. Metabolic acidosis with hyperkalemia
• B. Metabolic acidosis with hypokalemia
• C. Metabolic alkalosis with hyperkalemia
• D. Metabolic alkalosis with hypokalemia

Correct answer: D

Rationale: Frequent vomiting can lead to metabolic alkalosis with hypokalemia due to the loss of stomach acid and electrolytes.

2. The nurse is monitoring a client for the early signs of dumping syndrome. Which symptom indicates this occurrence?

• A. Abdominal cramping and pain
• B. Bradycardia and indigestion
• C. Sweating and pallor
• D. Double vision and chest pain

Correct answer: C

Rationale: Sweating and pallor are early signs of dumping syndrome, a condition where food moves too quickly from the stomach to the small intestine.

3. A nurse teaches a preoperative client about the nasogastric tube that will be inserted in preparation for surgery. The nurse determines that the client understands when the tube will be removed in the postoperative period when the client states

• A. When my gastrointestinal system is healed enough.
• B. When I can tolerate food without vomiting.
• C. When my bowels begin to function again, and I begin to pass gas.
• D. When the doctor says so.

Correct answer: C

Rationale: Nasogastric tubes are discontinued when normal function returns to the gastrointestinal tract. The tube will be removed before gastrointestinal healing. Food would not be administered unless bowel function returns. Although the physician determines when the nasogastric tube will be removed, option 4 does not determine effectiveness of teaching.

4. A nurse is preparing to remove a nasogastric tube from a client. The nurse would instruct the client to do which of the following just before the nurse removes the tube?

• A. To perform Valsalva’s maneuver
• B. To take hold and hold a deep breath
• C. To exhale
• D. To inhale and exhale quickly

Correct answer: B

Rationale: When the nurse removes a nasogastric tube, the client is instructed to take and hold a deep breath. This will be obstructed temporarily during the tube removal. This allows for easy withdrawal through the esophagus into the nose. The nurse removes the tube with one smooth, continuous pull.

5. Which of the following nursing measures would be inappropriate when caring for a client with a Cantor tube?

• A. Injecting 10 mL of air into the tube to facilitate drainage.
• B. Applying a water-soluble lubricant to the client's nares.
• C. Coiling extra tubing on the client's bed.
• D. Irrigating the tube with 50 mL of normal saline solution.

Correct answer: D

Rationale: Intestinal tubes are not irrigated. Injecting air into the tube, applying water-soluble lubricant, and coiling extra tubing are appropriate nursing measures.

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