Nokea
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: Failed to generate a rationale of 500+ characters after 5 retries.
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The nurse instructs the nursing assistant on how to provide oral hygiene for a client who cannot perform this task for himself. Which of the following techniques should the nurse tell the assistant to incorporate into the client's daily care?
- A. Assess the oral cavity each time mouth care is given and record observations
- B. Use a soft toothbrush to brush the client's teeth after each meal
- C. Swab the client's tongue, gums, and lips with a soft foam applicator every 2 hours.
- D. Rinse the client's mouth with mouthwash several times a day.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
After a subtotal gastrectomy, the nurse should anticipate that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery?
- A. Dark brown
- B. Bile green
- C. Bright red
- D. Cloudy white
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is reviewing the record of a client with Crohn's disease. Which of the following stool characteristics would the nurse expect to note documented in the client's record?
- A. Chronic constipation
- B. Diarrhea
- C. Constipation alternating with diarrhea
- D. Stool constantly oozing from the rectum
Correct Answer: B
Rationale: Crohn's disease is characterized by nonbloody diarrhea of usually not more than four to five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Chronic constipation (Choice A), constipation alternating with diarrhea (Choice C), and stool constantly oozing from the rectum (Choice D) are not characteristics typically associated with Crohn's disease.
The physician orders a Salem sump tube for gastrointestinal intubation. The nurse prepares for the insertion and obtains which of the following items from the supply room?
- A. A tube with a single lumen that connects to suction
- B. A tube with a large lumen and an air vent
- C. A Sengstaken-Blakemore tube
- D. A Dobbhoff weighted tube
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions?
- A. Supine with the head of the bed flat
- B. On the stomach with the head flat
- C. On the left side with the head of the bed elevated 30 degrees
- D. On the right side with the head of the bed elevated 30 degrees.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.