You’re patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority?

Ask the patient what happened, call the doctor, and cover the area with a water-soaked bedsheet.
Obtain vital signs, call the doctor, and obtain emergency orders.
Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees.
Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.

Solution

Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.

The student nurse is participating in colorectal cancer-screening program. Which patient has the fewest risk factors for colon cancer?

Janice, a 45 y.o. with a 25-year history of ulcerative colitis
George, a 50 y.o. whose father died of colon cancer
Herman, a 60 y.o. who follows a low-fat, high-fiber diet
Sissy, a 72 y.o. with a history of breast cancer

Solution

Herman, a 60 y.o. who follows a low-fat, high-fiber diet

80. Answer: 4. Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.

Your patient Maria takes NSAIDS for her degenerative joint disease, has developed peptic ulcer disease. Which drug is useful in preventing NSAID-induced peptic ulcer disease?

Calcium carbonate (Tums)
Famotidine (Pepcid)
Misoprostol (Cytotec)
Sucralfate (Carafate)

Solution

Misoprostol (Cytotec)

Misoprostol restores prostaglandins that protect the stomach from NSAIDS, which diminish the prostaglandins.

George has a T tube in place after gallbladder surgery. Before discharge, what information or instructions should be given regarding the T tube drainage?

“If there is any drainage, notify the surgeon immediately.”
“The drainage will decrease daily until the bile duct heals.”
“First, the drainage is dark green; then it becomes dark yellow.”
“If the drainage stops, milk the tube toward the puncture wound.”

Solution

“The drainage will decrease daily until the bile duct heals.”

As healing occurs from the bile duct, bile drains from the tube; the amount of bile should decrease. Teach the patient to expect dark green drainage and to notify the doctor if drainage stops.

Which stoma would you expect a malodorous, enzyme-rich, caustic liquid output that is yellow, green, or brown?

Ileostomy.
Ascending colostomy.
Transverse colostomy.
Descending colostomy.

Solution

Ileostomy.

The output from an Ileostomy is described.

Christina is receiving an enteral feeding that requires a concentration of 80 ml of supplement mixed with 20 ml of water. How much water do you mix with an 8 oz (240ml) can of feeding?

60 ml.
70 ml.
80 ml.
90 ml.

Solution

1. 60 ml.

Dosage problem. It’s 80/20 = 240/X. X=60.

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

Peristalsis.
Gastric acidity.
Gastric motility.
Gastric pH.

Solution

Gastric pH.

If the vagus nerve is cut as it enters the stomach, gastric acid secretion is decreased, but intestinal motility is also decreased and gastric emptying is delayed. Because gastric acids are decreased, gastric pH increases.

Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?

He has fresh, active upper GI bleeding.
He needs immediate saline gastric lavage.
His gastric bleeding occurred 2 hours earlier.
He needs a transfusion of packed RBC’s.

Solution

His gastric bleeding occurred 2 hours earlier.

Coffee-ground emesis occurs when there is upper GI bleeding that has undergone gastric digestion. For blood to appear as coffee-ground emesis, it would have to be digested for approximately 2 hours.

Your patient with peritonitis is NPO and complaining of thirst. What is your priority?

Increase the I.V. infusion rate.
Use diversion activities.
Provide frequent mouth care.
Give ice chips every 15 minutes.

Solution

Provide frequent mouth care.

Frequent mouth care helps relieve dry mouth.

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