ATI RN
ATI Gastrointestinal System
1. The nurse is caring for a client following a Billroth II procedure. On review of the post-operative orders, which of the following, if prescribed, would the nurse question and verify?
- A. Irrigating the nasogastric tube
- B. Coughing a deep breathing exercises
- C. Leg exercises
- D. Early ambulation
Correct answer: A
Rationale: Irrigating the nasogastric tube is typically not recommended after a Billroth II procedure unless specifically ordered by a physician due to the risk of disrupting the surgical site.
2. 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.
3. After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery?
- A. Dark brown
- B. Bile green
- C. Bright red
- D. Cloudy white
Correct answer: A
Rationale: Dark brown drainage is expected for about 12 to 24 hours after surgery.
4. When planning care for a client with ulcerative colitis who is experiencing symptoms, which client care activities can the nurse appropriately delegate to a unlicensed assistant?
- A. Assessing the client's bowel sounds
- B. Providing skin care following bowel movements
- C. Evaluating the client's response to antidiarrheal medications
- D. administration of pain medication every 4 hours
Correct answer: B
Rationale: Providing skin care following bowel movements, maintaining intake and output records, and obtaining the client's weight can be delegated to a unlicensed assistant.
5. The client is admitted to the hospital for treatment of acute hepatitis B. Which activity order would the nurse expect to be prescribed?
- A. Bedrest
- B. Encourage ambulation
- C. Out of bed in a chair
- D. No activity restrictions
Correct answer: A
Rationale: Fatigue is a normal response to hepatic cellular damage. During the acute stage, rest is an essential intervention to reduce the metabolic demands on the liver and its blood supply.
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