Nokea
Following an esophagectomy with colon interposition (esophagoenterostomy) for esophageal cancer, the client is beginning to eat oral foods. The nurse monitors for aspiration because the client no longer has which structure?
- A. A stomach
- B. A pyloric sphincter
- C. A pharynx
- D. A lower esophageal sphincter
Correct Answer: D
Rationale: A. All or part of the stomach will remain intact following an esophagoenterostomy. B. The pyloric sphincter will remain intact following an esophagoenterostomy. C. The pharynx will remain intact following an esophagoenterostomy. D. An esophagectomy for cancer involves removal of the lower esophageal sphincter, which normally functions to keep food from refluxing back into the esophagus. The absence of the lower esophageal sphincter places the client at risk for aspiration.
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The client is diagnosed with irritable bowel syndrome (IBS). Which intervention should the nurse teach the client to reduce symptoms?
- A. Instruct the client to avoid drinking fluids with meals.
- B. Explain the need to decrease intake of flatus-forming foods.
- C. Teach the client how to perform gentle perianal care.
- D. Encourage the client to attend a support group meeting.
Correct Answer: B
Rationale: Decreasing flatus-forming foods (e.g., beans, broccoli) reduces bloating and discomfort in IBS. Avoiding fluids with meals is not standard, perianal care is secondary, and support groups are psychosocial.
The 20-year-old female is being admitted to the hospital with exacerbation of Crohn’s disease. The client is alert and oriented and has been taking azathioprine for disease control. Into which room should the charge nurse place the client?
- A. Private room across from the nurse’s station
- B. Room with a female who has Crohn’s disease
- C. Private room that has a private attached bathroom
- D. Room with an elderly female who is on bedrest
Correct Answer: C
Rationale: A. The client is alert and oriented; there is no need to be near the nurse’s station. B. The client is at an increased risk for infection and should have a private room rather than rooming with another female with Crohn’s disease. C. The client should be in a private room with a private bathroom due to an increased risk for infection with azathioprine (Imuran). Azathioprine suppresses cell-mediated immune responses and may cause bone marrow suppression. It is also a biohazard medication. D. The client is at an increased risk for infection and should have a private room rather than rooming with another female.
The client with a newly created colostomy is concerned about having satisfying sexual relations. What should the nurse recommend?
- A. Participate in sexual activity only in a darkened room.
- B. Utilize self-gratification for the majority of sexual needs.
- C. Empty and clean the ostomy bag just before sexual activity.
- D. Utilize only the female superior position for sexual activity.
Correct Answer: C
Rationale: Emptying the pouch before sexual activity is recommended to decrease the concern of pouch breakage or leakage; cleaning it will reduce odor.
A child with appendicitis is scheduled for surgery this evening. The nurse enters the room and sees the child's mother starting to place hot, wet washcloths on her daughter's abdomen so that 'she will feel better.' The nurse explains that this action is contraindicated because heat:
- A. can cause the appendix to rupture and cause peritonitis.
- B. can mask symptoms of acute appendicitis.
- C. will increase peristalsis throughout the abdomen.
- D. will arrest progression of the disease.
Correct Answer: A
Rationale: Heat can increase inflammation and blood flow, risking appendix rupture and peritonitis in appendicitis.
The nurse is caring for the client to manage and decrease the sensation of nausea. Which nonpharmacological intervention should the nurse recommend?
- A. Sipping tea made from gingerroot
- B. Changing positions more rapidly
- C. Decreasing intake of solid food
- D. Playing stimulating classical music
Correct Answer: A
Rationale: A. Ginger has demonstrated antiemetic properties as well as analgesic and sedative effects on GI motility. B. Avoidance of sudden changes in position and decreasing activity are recommended to control nausea. C. All food should be stopped when nausea is present to prevent stomach stretching and stimulation of the afferent nerve fibers. D. A quiet, calm environment, rather than one that is stimulating, is recommended to decrease nausea.