Nursing Elites

1. A nurse has been caring for a client with a Sengstaken-Blakemore tube. The physician arrives on the nursing unit and deflates the esophageal balloon. The nurse should monitor the client most closely for which of the following?

• A. Swelling of the abdomen
• B. Bloody diarrhea
• C. Vomiting blood
• D. An elevated temperature and arise in blood pressure

Correct answer: C

Rationale: A Sengstaken-Blakemore tube is inserted into a client with a diagnosis of cirrhosis and ruptured esophageal varices. The tube has an esophageal and a gastric balloon. The esophageal balloon exerts pressure on the bleeding. The pressure of the esophageal balloon is released at intervals to decrease the risk of trauma to esophageal tissues, including esophageal rupture or necrosis. When the balloon is deflated the client may begin to bleed again from the esophageal varices, noted by vomiting of blood.

2. Risk factors for the development of hiatal hernias are those that lead to increased abdominal pressure. Which of the following complications DOES NOT cause increased abdominal pressure?

• A. Obesity
• B. Volvulus
• C. Constipation
• D. Intestinal obstruction

Correct answer: B

Rationale: Obesity, constipation, and intestinal obstruction can all lead to increased abdominal pressure, which in turn can cause a hiatal hernia.

3. The most important pathophysiologic factor contributing to the formation of esophageal varices is:

• A. Decreased prothrombin formation
• B. Decreased albumin formation by the liver
• C. Portal hypertension
• D. Increased central venous pressure

Correct answer: C

Rationale: Portal hypertension is the most important pathophysiologic factor contributing to the formation of esophageal varices.

4. A patient with Crohn’s disease is admitted after 4 days of diarrhea. Which of the following urine specific gravity values do you expect to find in this patient?

• A. 1.005
• B. 1.011
• C. 1.02
• D. 1.03

Correct answer: D

Rationale: A urine specific gravity of 1.030 indicates concentrated urine, which is expected in a patient with dehydration due to diarrhea from Crohn’s disease.

5. The nurse is reviewing the physician’s orders written for a client admitted with acute pancreatitis. Which physician order would the nurse question if noted on the client’s chart?

• A. NPO status
• B. Insert a nasogastric tube
• C. An anticholinergic medication
• D. Morphine for pain

Correct answer: D

Rationale: Morphine for pain should be questioned as it can cause spasms of the sphincter of Oddi, worsening pancreatitis.

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