Nursing Elites

1. The client has orders for a nasogastric (NG) tube insertion. During the procedure, instructions that will assist in the insertion would be:

• A. Instruct the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion
• B. After insertion into the nostril, instruct the client to extend his neck
• C. Introduce the tube with the client’s head tilted back, then instruct him to keep his head upright for final insertion
• D. Instruct the client to hold his chin down, then back for insertion of the tube

Correct answer: A

Rationale: Instructing the client to tilt his head back for insertion in the nostril, then flex his neck for the final insertion helps facilitate the NG tube insertion.

2. Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis?

• A. Treating constipation with chronic laxative use, leading to dependence on laxatives
• B. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents
• C. Herniation of the intestinal mucosa, rupturing the wall of the intestine
• D. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion

Correct answer: D

Rationale: The correct answer is D. Undigested food blocking the diverticulum can lead to bacterial invasion, causing inflammation and turning diverticulosis into diverticulitis. Choices A, B, and C do not directly facilitate the development of diverticulitis. Choice A involves a different mechanism related to laxative use, choice B describes a complication of chronic constipation but does not necessarily lead to diverticulitis, and choice C refers to a different condition involving herniation of the intestinal mucosa.

3. 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.

4. 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.

5. The nurse is scheduling diagnostic tests for a client. If all of the following diagnostic tests are ordered, which would be performed last?

• A. Gallbladder series
• B. Barium enema
• C. Barium swallow
• D. Oral cholecystogram

Correct answer: C

Rationale: The correct answer is C, 'Barium swallow.' A barium swallow should be done after a barium enema or gallbladder series to prevent the contrast used in the barium swallow from obstructing the view of other organs. It takes several days for swallowed barium to pass completely out of the gastrointestinal tract. Choices A, B, and D are incorrect because a barium swallow should be the last test performed to ensure clear imaging without interference from residual contrast material.

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