Nursing Elites

1. Hepatic encephalopathy develops when the blood level of which substance increases?

• A. Ammonia
• B. Amylase
• C. Calcium
• D. Potassium

Correct answer: A

Rationale: Hepatic encephalopathy develops when the blood level of ammonia increases.

2. Findings during an endoscopic exam include a cobblestone appearance of the colon in your patient. The findings are characteristic of which disorder?

• A. Ulcer
• B. Crohn’s disease
• C. Chronic gastritis
• D. Ulcerative colitis

Correct answer: B

Rationale: The cobblestone appearance of the colon is characteristic of Crohn’s disease.

3. Lactulose (Chronulac) is prescribed for a client with a diagnosis of hepatic encephalopathy. The nurse would determine that this medication has had a therapeutic effect if which of the following is noted?

• A. Increased red blood cell count
• B. Decreased serum ammonia level
• C. Increased protein level
• D. Decreased white blood cell level

Correct answer: B

Rationale: Lactulose is prescribed for the client with hepatic encephalopathy to reduce bacterial breakdown of protein in the bowel. The medication creates an acidic environment in the bowel and causes the ammonia to leave the bloodstream and enter the colon. Ammonia then becomes trapped in the bowel. Lactulose also has a laxative effect that allows for the elimination of the ammonia.

4. The nurse instructs the ileostomy client to do which of the following as a part of essential care of the stoma?

• A. Cleanse the peristomal skin meticulously
• B. Take in high-fiber foods such as nuts
• C. Massage the area below the stoma
• D. Limit fluid intake to prevent diarrhea.

Correct answer: A

Rationale: Cleansing the peristomal skin meticulously is crucial to prevent irritation and infection around the stoma.

5. George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage?

• A. If there is any drainage, notify the surgeon immediately.
• B. The drainage will decrease daily until the bile duct heals.
• C. First, the drainage is dark green; then it becomes dark yellow.
• D. If the drainage stops, milk the tube toward the puncture wound.

Correct answer: B

Rationale: Before discharge, inform the patient that the drainage will decrease daily until the bile duct heals.

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