Nokea
The nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to:
- A. restrict fluid intake to 1 qt (1,000 ml)/day.
- B. drink liquids only with meals.
- C. don't drink liquids 2 hours before meals.
- D. drink liquids only between meals.
Correct Answer: D
Rationale: The correct answer is D: drink liquids only between meals. This is because restricting fluids during meals can worsen dumping syndrome by rapidly emptying the stomach contents into the intestines, causing symptoms like cramping and diarrhea. By advising the client to drink liquids only between meals, it allows for better digestion and absorption of nutrients, reducing the risk of dumping syndrome.
Choice A is incorrect because restricting fluid intake can lead to dehydration and other complications. Choice B is incorrect as drinking liquids with meals can exacerbate dumping syndrome symptoms. Choice C is incorrect as not drinking liquids before meals may not effectively manage dumping syndrome and can lead to dehydration.
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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: The correct answer is B: Oil-soluble lubricant. The rationale is that oil-based lubricants should not be used for nasogastric tube insertion due to the risk of aspiration pneumonia. The other options are appropriate for the procedure: A) Tape is used to secure the tube, C) Water with a straw is used to check tube placement, and D) A syringe is used for verification of tube placement and administration of medications. Therefore, selecting B indicates a lack of understanding of proper supplies for nasogastric tube insertion.
Of the following signs and symptoms of bowel obstruction, which is related primarily to small bowel obstruction rather than large bowel obstruction?
- A. Profuse vomiting.
- B. Cramping abdominal pain.
- C. Abdominal distention.
- D. High-pitched bowel sounds above the obstruction.
Correct Answer: A
Rationale: The correct answer is A: Profuse vomiting. In small bowel obstruction, the vomitus is typically profuse, as the small bowel is narrower and more distensible than the large bowel. This leads to rapid accumulation of gastric contents resulting in frequent vomiting. Cramping abdominal pain (B) can occur in both small and large bowel obstruction. Abdominal distention (C) is a common symptom in both types of obstruction due to the accumulation of gas and fluid. High-pitched bowel sounds above the obstruction (D) are indicative of partial obstruction and can be present in both small and large bowel obstruction.
The client with chronic pancreatitis needs information on dietary modification to manage the health problem. The nurse teaches the client to limit which of the following items in the diet?
- A. Carbohydrate
- B. Protein
- C. Fat
- D. Water-soluble vitamins
Correct Answer: C
Rationale: The correct answer is C: Fat. In chronic pancreatitis, the pancreas struggles to produce digestive enzymes, leading to poor fat digestion. Limiting fat intake can help reduce symptoms like abdominal pain and diarrhea. Carbohydrates and proteins are essential for energy and tissue repair, so limiting them is not ideal. Water-soluble vitamins are generally well-absorbed and do not require restriction in chronic pancreatitis.
A client is suspected of having hepatitis. Which diagnostic test results will assist in confirming this diagnosis?
- A. Decreased erythrocyte sedimentation rate
- B. Elevated serum bilirubin
- C. Elevated hemoglobin
- D. Elevated blood urea nitrogen
Correct Answer: B
Rationale: The correct answer is B: Elevated serum bilirubin. Hepatitis is characterized by liver inflammation, which can lead to impaired bilirubin metabolism and increased levels in the blood. Elevated serum bilirubin is a common finding in hepatitis. Decreased erythrocyte sedimentation rate (Choice A) is not specific to hepatitis. Elevated hemoglobin (Choice C) and elevated blood urea nitrogen (Choice D) are not typically associated with hepatitis and are more indicative of other conditions. In summary, elevated serum bilirubin is a key diagnostic marker for confirming a diagnosis of hepatitis.
The nurse is performing an assessment on a client with acute pancreatitis who was admitted to the hospital. Which of the following assessment questions most specifically would elicit information regarding the pain that is associated with acute pancreatitis?
- A. Does the pain in your abdomen radiate to your groin.
- B. Does the pain in your stomach radiate to the back?
- C. Does the pain in your stomach radiate to your lower middle abdomen?
- D. Does the pain in your lower abdomen radiate to the hip?
Correct Answer: B
Rationale: The correct answer is B: "Does the pain in your stomach radiate to the back?" This question is specific to acute pancreatitis as the pain typically radiates from the epigastric area to the back. Pancreatitis pain often presents as severe, constant, and radiating to the back due to the inflammation of the pancreas affecting surrounding structures.
Choice A is incorrect as the pain in acute pancreatitis typically radiates to the back, not the groin. Choice C is incorrect as it specifies a different area in the abdomen, not the typical location for pancreatitis pain. Choice D is incorrect as pancreatitis pain does not typically radiate to the hip.
In summary, understanding the characteristic radiation of pain in acute pancreatitis is key to assessing and differentiating it from other abdominal conditions.