Nursing Elites

1. 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.

2. The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to:

• A. Check that the hemostat is on the bedside
• B. Monitor IV fluids for the shift
• C. Regularly assess respiratory status
• D. Check that the balloon is deflated on a regular basis

Correct answer: C

Rationale: Regularly assessing respiratory status is crucial when a Sengstaken-Blakemore tube is inserted to control bleeding in esophageal varices.

3. The nurse provides medication instructions to a client with peptic ulcer disease. Which statement, if made by the client, indicates best understanding of the medication therapy?

• A. The cimetidine (Tagamet) will cause me to produce less stomach acid.
• B. Sucralfate (Carafate) will change the fluid in my stomach.
• C. Antacids will coat my stomach.
• D. Omeprazole (Prilosec) will coat the ulcer and help it heal.

Correct answer: A

Rationale: Cimetidine (Tagamet) a Histamine H2 receptor antagonist, will decrease the secretion of gastric acid. Sucralfate (Carafate) promotes healing by coating the ulcer. Antacids neutralize acid in the stomach. Omeprazole (Prilosec) inhibits gastric acid secretion.

4. Which of the following expected outcomes would be appropriate for the client who has ulcerative colitis?

• A. The client maintains a daily record of intake and output.
• B. The client verbalizes the importance of small, frequent feedings.
• C. The client uses a heating pad to decrease abdominal cramping.
• D. The client accepts that a colostomy is inevitable at some time in his life.

Correct answer: B

Rationale: Small, frequent feedings are better tolerated by clients with ulcerative colitis as they lessen the amount of fecal material present in the gastrointestinal tract and decrease stimulation. The client does not need to maintain a daily record of intake and output unless an exacerbation of the disease occurs. A heating pad should not be applied to the intestine as it is inflamed. It is not inevitable that the client will require surgery to treat ulcerative colitis.

5. The nurse is providing discharge instructions to a client following gastrectomy. Which measure will the nurse instruct the client to follow to assist in preventing dumping syndrome?

• A. Eat high-carbohydrate foods
• B. Limit the fluids taken with meals
• C. Ambulate following a meal
• D. Sit in a high-Fowlers position during meals

Correct answer: B

Rationale: To prevent dumping syndrome after a gastrectomy, it is recommended to limit fluids taken with meals to slow down gastric emptying and reduce the symptoms.

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