Nursing Elites

1. Which of the following definitions best describes gastritis?

• A. Erosion of the gastric mucosa
• B. Inflammation of a diverticulum
• C. Inflammation of the gastric mucosa
• D. Reflux of stomach acid into the esophagus

Correct answer: C

Rationale: The correct answer is C: 'Inflammation of the gastric mucosa.' Gastritis is characterized by inflammation of the stomach lining, specifically the gastric mucosa. This inflammation can be caused by various factors such as infections, medications, alcohol, or autoimmune diseases. Choice A, 'Erosion of the gastric mucosa,' is incorrect because erosion refers to the wearing away of tissue rather than inflammation. Choice B, 'Inflammation of a diverticulum,' is incorrect because gastritis specifically involves inflammation of the stomach lining, not a diverticulum. Choice D, 'Reflux of stomach acid into the esophagus,' describes gastroesophageal reflux disease (GERD), which is different from gastritis.

2. 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.

3. You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority?

• A. Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.
• B. Obtain vital signs, call the doctor, and obtain emergency orders.
• C. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees.
• D. Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.

Correct answer: D

Rationale: For a patient with a ruptured wound and protruding bowel, call the doctor while remaining with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.

4. A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the midepigastric area along with a rigid, boardlike abdomen. These clinical manifestations most likely indicate which of the following?

• A. An intestinal obstruction has developed
• B. Additional ulcers have developed
• C. The esophagus has become inflamed
• D. The ulcer has perforated

Correct answer: D

Rationale: A sudden, sharp pain in the midepigastric area along with a rigid, boardlike abdomen indicates that the ulcer has perforated.

5. Before administering an intermittent tube feeding through a nasogastric tube, the nurse assesses for gastric residual. The nurse understands that this procedure is important to

• A. Confirm proper nasogastric tube placement.
• B. Observe gastric contents.
• C. Assess fluid and electrolyte status.
• D. Evaluate absorption of the last feeding.

Correct answer: D

Rationale: Evaluating the absorption of the last feeding is important because administration of a tube feeding to a full stomach could result in overdistention, thus predisposing the client to regurgitation and possible aspiration.

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