Nursing Elites

1. Your patient has a retractable gastric peptic ulcer and has had a gastric vagotomy. Which factor increases as a result of vagotomy?

• A. Peristalsis.
• B. Gastric acidity.
• C. Gastric motility.
• D. Gastric pH.

Correct answer: D

Rationale: After a gastric vagotomy, the gastric pH increases as a result of reduced acid secretion.

2. The nurse is preparing to discontinue a client’s nasogastric tube. The client is positioned properly, and the tube has been flushed with 15 mL of air to clear secretions. Before removing the tube, the nurse makes which statement to the client?

• A. Take a deep breath when I tell you and breathe normally while I remove the tube.
• B. Take a deep breath when I tell you and bear down while I remove the tube.
• C. Take a deep breath when I tell you and slowly exhale while I remove the tube.
• D. Take a deep breath when I tell you and hold it while I remove the tube.

Correct answer: C

Rationale: The client should take a deep breath because the client’s airway will be obstructed temporarily during tube removal. The nurse then tells the client to exhale slowly and withdraws the tube during exhalation. Bearing down could inhibit the removal of the tube. Breathing normally could result in aspiration of gastric secretions during inhalation. Holding the breath does not facilitate tube removal.

3. Your patient, Christopher, has a diagnosis of ulcerative colitis and has severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output. This may indicate which complication?

• A. Fistula.
• B. Bowel perforation.
• C. Bowel obstruction.
• D. Abscess.

Correct answer: B

Rationale: Severe abdominal pain aggravated by movement, rebound tenderness, fever, nausea, and decreased urine output in a patient with ulcerative colitis may indicate bowel perforation.

4. Crohn’s disease can be described as a chronic relapsing disease. Which of the following areas in the GI system may be involved with this disease?

• A. The entire length of the large colon
• B. Only the sigmoid area
• C. The entire large colon through the layers of mucosa and submucosa
• D. The small intestine and colon; affecting the entire thickness of the bowel

Correct answer: D

Rationale: Crohn's disease can affect any part of the gastrointestinal tract from the mouth to the anus, but it commonly affects the small intestine and colon, involving the entire thickness of the bowel wall.

5. A nurse orientee is preparing to insert a nasogastric tube, and a nurse educator is observing the procedure. Which of the following supplies if obtained by the nurse orientee would indicate a need for further education regarding this procedure?

• A. Half-inch or one-inch tape
• B. Oil-soluble lubricant
• C. A glass of tap water with a straw
• D. A 50-mL catheter tip syringe

Correct answer: B

Rationale: Water-soluble lubricant is used to lubricate 3 to 4 inches of the tube at the insertion end. An oil lubricant is not used because if the tube accidentally goes into the bronchus, pneumonia can develop. Half-inch tape is used to secure the tube after the correct placement is verified. A 50-mL catheter tip syringe is used to aspirate gastric contents to confirm placement. The client will be asked to take a sip of water through a straw to help with the passage of the tube.

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