Nursing Elites

1. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?

• A. He has fresh, active upper GI bleeding.
• B. He needs immediate saline gastric lavage.
• C. His gastric bleeding occurred 2 hours earlier.
• D. He needs a transfusion of packed RBCs.

Correct answer: C

Rationale: Coffee-ground emesis is a sign of upper gastrointestinal bleeding that occurred approximately 2 hours earlier. It results from the breakdown of blood in the stomach due to digestive enzymes, giving it a coffee-ground appearance. Choice A is incorrect because coffee-ground emesis indicates older, partially digested blood, not fresh active bleeding. Choice B is incorrect as gastric lavage is not indicated for coffee-ground emesis. Choice D is incorrect because a transfusion of packed RBCs is not the immediate management for this presentation.

2. Which area of the alimentary canal is the most common location for Crohn’s disease?

• A. Ascending colon
• B. Descending colon
• C. Sigmoid colon
• D. Terminal ileum

Correct answer: D

Rationale: The terminal ileum is the most common location for Crohn's disease.

3. During an abdominal assessment, a nurse finds pulsation between the umbilicus and pubis on a client. What finding should be reported to the physician?

• A. Concave, midline umbilicus
• B. Pulsation between the umbilicus and pubis
• C. Bowel sound frequency of 15 sounds per minute
• D. Absence of a bruit

Correct answer: B

Rationale: The presence of pulsation between the umbilicus and pubis could indicate an abdominal aortic aneurysm, which is a serious condition and should be reported to the physician promptly. A concave, midline umbilicus is a normal finding. Bowel sound frequency can vary widely and is not a cause for concern at 15 sounds per minute. Absence of a bruit is a normal finding in an abdominal assessment and does not require reporting.

4. When teaching an elderly client how to prevent constipation, which of the following instructions should the nurse include?

• A. Drink 6 glasses of fluid each day.
• B. Avoid grain products and nuts.
• C. Add at least 4 grams of brain to your cereal each morning.
• D. Be sure to get regular exercise.

Correct answer: D

Rationale: To prevent constipation, elderly clients should be encouraged to get regular exercise, which promotes bowel motility.

5. Which goal of the client’s care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis?

• A. Promoting self-care and independence
• B. Managing diarrhea
• C. Maintaining adequate nutrition
• D. Promoting rest and comfort

Correct answer: B

Rationale: Managing diarrhea should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis.

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