Nursing Elites

1. Which of the following conditions can cause a hiatal hernia?

• A. Increased intrathoracic pressure
• B. Weakness of the esophageal muscle
• C. Increased esophageal muscle pressure
• D. Weakness of the diaphragmic muscle

Correct answer: D

Rationale: Weakness of the diaphragmic muscle can lead to a hiatal hernia as it allows part of the stomach to push through the diaphragm into the chest cavity.

2. A nurse is preparing to remove a nasogastric tube from a client. The nurse would instruct the client to do which of the following just before the nurse removes the tube?

• A. To perform Valsalva’s maneuver
• B. To take hold and hold a deep breath
• C. To exhale
• D. To inhale and exhale quickly

Correct answer: B

Rationale: When the nurse removes a nasogastric tube, the client is instructed to take and hold a deep breath. This will be obstructed temporarily during the tube removal. This allows for easy withdrawal through the esophagus into the nose. The nurse removes the tube with one smooth, continuous pull.

3. Regina is a 46 y.o. woman with ulcerative colitis. You expect her stools to look like:

• A. Watery and frothy.
• B. Bloody and mucoid.
• C. Firm and well-formed.
• D. Alternating constipation and diarrhea.

Correct answer: B

Rationale: Stools in ulcerative colitis are typically bloody and mucoid.

4. The nurse is preparing a discharge teaching plan for the client who had an umbilical hernia repair. Which of the following would the nurse include in the plan?

• A. Restricting pain medication
• B. Maintaining bedrest
• C. Avoiding coughing
• D. Irrigating the drain

Correct answer: C

Rationale: To prevent strain on the surgical site and avoid disruption of tissue integrity, the client should avoid coughing after an umbilical hernia repair.

5. A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:

• A. Absence of nausea and vomiting.
• B. Passage of mucus from the rectum.
• C. Passage of flatus and feces from the colostomy.
• D. Absence of stomach drainage for 24 hours.

Correct answer: C

Rationale: A sign indicating that a client's colostomy is open and ready to function is passage of feces and flatus. When this occurs, gastric suction is ordinarily discontinued, and the client is allowed to start taking fluids and food orally. Absence of bowel sounds would indicate that the tube should remain in place because peristalsis has not yet returned. Absence of nausea and vomiting is not a criterion for judging whether or not gastric suction should be continued. Passage of mucus from the rectum will not occur in this client because the rectum is removed in this surgery. Absence of stomach drainage is not a criterion for judging whether or not gastric suction should be continued.

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