Nursing Elites

1. Which of the following symptoms is common with a hiatal hernia?

• A. Left arm pain
• B. Lower back pain
• C. Esophageal reflux
• D. Abdominal cramping

Correct answer: C

Rationale: Esophageal reflux is a common symptom of a hiatal hernia because the hernia can cause stomach acid to move back up into the esophagus.

2. A client with viral hepatitis is discussing with the nurse the need to avoid alcohol and states, 'I’m not sure I can avoid alcohol.' The most appropriate response is

• A. Everything will be alright.
• B. I think you should talk more with the doctor about this.
• C. I don’t believe that.
• D. I’m not sure that I don’t understand. Would you please explain?

Correct answer: D

Rationale: The most appropriate response in this situation is to seek clarification from the client by saying, 'I’m not sure that I don’t understand. Would you please explain?' This response shows empathy and a willingness to listen, encouraging the client to elaborate on their concerns. False reassurance (Choice A) is not helpful as it dismisses the client's feelings. Suggesting to talk more with the doctor (Choice B) may deflect from addressing the client's immediate concerns. Expressing disbelief (Choice C) can create a barrier to open communication, making the client feel unsupported.

3. Which of the following would be an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer?

• A. Regain weight loss within 1 month after surgery
• B. Resume normal dietary intake of three meals per day
• C. Control nausea and vomiting through regular use of antiemetics
• D. Achieve optimal nutritional status through oral or parenteral feedings

Correct answer: D

Rationale: Achieving optimal nutritional status through oral or parenteral feedings is an expected nutritional outcome for a client who has undergone a subtotal gastrectomy for cancer.

4. Which area of the alimentary canal is the most common location for Crohn’s disease?

• A. Ascending colon
• B. Descending colon
• C. Sigmoid colon
• D. Terminal ileum

Correct answer: D

Rationale: The terminal ileum is the most common location for Crohn's disease.

5. A client returns from surgery with a sigmoid colostomy. An ostomy appliance is attached. The priority nursing diagnosis for daily observation and care is:

• A. Diarrhea related to alteration in bowel elimination.
• B. Impaired skin integrity related to seepage.
• C. Impaired nutrition: More than body requirements related to high-fat diet.
• D. Impaired physical mobility related to surgical procedure.

Correct answer: B

Rationale: Impaired skin integrity would be the priority nursing diagnosis for daily care of the colostomy because the effluent from the colostomy can be irritating to the skin. Diarrhea isn't a concern at this point. The client will be allowed nothing by mouth until peristalsis returns. The client should get out of bed on the first postoperative day, so mobility shouldn't be a problem.

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