Nokea
The client's family asks why the client who had a splenectomy has a nasogastric (NG) tube. An NG tube is used to:
- A. Move the stomach away from where the spleen was removed.
- B. Irrigate the operative site.
- C. Decrease abdominal distention.
- D. Assess for the gastric pH as peristalsis returns.
Correct Answer: C
Rationale: An NG tube is used post-splenectomy to decompress the stomach and decrease abdominal distention, which can reduce pressure on the surgical site and promote healing. It does not move the stomach, irrigate the site, or assess gastric pH.
You may also like to solve these questions
What is the priority nursing action for a client with a suspected brain tumor?
- A. Administer pain medication.
- B. Monitor neurological status.
- C. Provide emotional support.
- D. Restrict physical activity.
Correct Answer: B
Rationale: Monitoring neurological status is the priority to detect changes associated with a brain tumor.
The nurse will anticipate which of the following problems that can result for the older adult undergoing abdominal surgery?
- A. Uncrossed scarring.
- B. Decreased melanin and melanocytes.
- C. Decreased healing.
- D. Increased immunocompetence.
Correct Answer: C
Rationale: Older adults have slower wound healing due to reduced collagen synthesis and cellular turnover, increasing the risk of delayed recovery post-surgery.
The client with colon cancer has an abdominal-perineal resection with a colostomy. Which of the following nursing interventions is most appropriate for this client in the postoperative period?
- A. Maintain the client in a semi-Fowler's position.
- B. Assist the client with warm sitz baths.
- C. Administer 30 mL of milk of magnesia to stimulate colostomy activity.
- D. Remove the ostomy pouch as needed so the stoma can be assessed.
Correct Answer: B
Rationale: Appropriate nursing interventions after an abdominal-perineal resection with a colostomy include assisting the client with warm sitz baths three to four times a day to clean the perineal incision. The client will be more comfortable assuming a side-lying position because of the perineal incision. It would be inappropriate to administer milk of magnesia to stimulate colostomy activity. Stool passage will begin as peristalsis returns. It is not necessary to be available to change the ostomy pouch to assess the stoma. The ostomy pouch should be transparent to allow easy observation of the stoma and drainage. CN: Physiological adaptation; CL: Synthesize
When the nurse talks with a client with multiple sclerosis who has slurred speech, which nursing intervention is contraindicated?
- A. Encouraging the client to speak slowly.
- B. Allowing extra time for the client to respond.
- C. Asking the client to repeat indistinguishable words.
- D. Asking the client to speak louder when tired.
Correct Answer: D
Rationale: Asking the client to speak louder when tired is contraindicated, as it may exacerbate fatigue and worsen speech. Encouraging slow speech, allowing time, and repeating words support communication.
The nurse should teach the diabetic client that which of the following is the most common symptom of hypoglycemia?
- A. Nervousness.
- B. Anorexia.
- C. Kussmaul's respirations.
- D. Bradycardia.
Correct Answer: A
Rationale: Nervousness is a common symptom of hypoglycemia due to the body's stress response to low blood glucose levels.