Question 1

What nursing action best facilitates the passage of the nasoenteric tube from the stomach through the pylorus and into the duodenum?&#10;A)Gently advancing the tube 1-4 inches at regular time intervals&#10;B)Positioning the client on the right side for 2 hours after insertion&#10;C)Maintaining strict bed rest and avoiding all unnecessary movement&#10;D)Positioning the client in a flat supine position

Accepted Answer

After the tube has been inserted into the stomach, its movement into the duodenum is first facilitated by having the client lie on the right side for 2 hours, then on the back with head elevated for 2 hours, and finally on the left side for 2 hours. After the tube has passed the pylorus (this is usually checked by X-ray), ambulating the client will help move the tube to the point of obstruction. After positioning and ambulation, the physician or the nurse may advance the tube 1 to 4 inches at specified time intervals (Choice A) to provide slack for peristalsis action. Remaining quiet or flat in bed (Choices C and D) will not facilitate the advancement of the tube either through the pylorus or through the small intestine.

Question 2

The mouth care measure that should be used with caution by the nurse when a client has a nasogastric tube is:&#10;A)Regularly brushing teeth and tongue with soft brush&#10;B)Sucking on ice chips to relieve dryness&#10;C)Occasionally rinsing mouth with a non-astringent substance and massaging gums&#10;D)Application of lemon juice and glycerine swabs to the lips

Accepted Answer

The client should be cautioned to limit the number of ice chips he or she sucks on because the nasogastric suction will remove not only the increased water ingested from the melted chips, but also essential electrolytes. Other options are all appropriate mouth care measures.

Question 3

After her gastrectomy, actress Sandra Newton asks the nurse when the nasogastric tube will be removed. The nurse responds ______________.&#10;A)&#34;According to standard procedures only, it will be removed on the fourth postoperative day.&#34;&#10;B)&#34;When bowel sounds are established and you have passed flatus or stool.&#34;&#10;C)&#34;Thirty-six hours after the cessation of bloody drainage.&#34;&#10;D)&#34;After two days of alternate clamping and unclamping of the tube.&#34;

Accepted Answer

The nasogastric tube is removed after bowel sounds have been reestablished (generally around the third day) and after the client has passed flatus or stool. Choices A and C are incorrect because they do not include the return of bowel sounds. Before removal, the tube is frequently clamped for 2 to 4 hours
not 2 days (Choice D)
to test the client's tolerance. Gastric residue is measured after this period. If it is more than 100ml, the nasogastric tube is left in place. Likewise, if the client experiences any pain, nausea, vomiting, or distention during this period, the tube is left in. If no symptoms occur and there is minimal amount of gastric residue, the tube is removed.

Question 4

Following gastrectomy, the nurse must observe for signs of pernicious anemia because:&#10;A)The extrinsic factor is produced in the stomach&#10;B)The extrinsic factor is absorbed in the antral portion of the stomach&#10;C)The intrinsic factor is produced in the stomach&#10;D)Decreased hydrochloride acid production inhibits vitamin B12 reabsorption

Accepted Answer

Pernicious anemia may occur following subtotal gastrectomy (when large portions of the stomach are removed) due to the loss of tissue that produces the intrinsic factor.

Question 5

Seuss, a music teacher, is diagnosed with chronic pancreatitis and pancrelipase (Lipancreatin) is prescribed. Which of the following instructions should the nurse give to this client about the administration of this medication?

A)"Take the drug with meals."
B)"Take the drug with a large glass of milk."
C)"Take the drug between meals."
D)"Take the drug after it is crushed and mixed with ice cream."

Accepted Answer

Pancrelipase (Lipancreatin) aids in the digestion of starches and fats and should be taken with meals. It should not be crushed since hydrochloric acid destroys the drug and it should not be mixed with alkaline foods (milk, ice cream).

Question 6

Tom, 45 years old and a known alcoholic, came into the Emergency Department complaining of constant epigastric abdominal pain that radiates to the back and flank areas. He further states that the pain is more intense when he lies down. After a thorough examination, the doctor wrote in the client's chart his admitting diagnosis as acute pancreatitis. The nurse is aware that she should report immediately if Tom develops __________.

A)Nausea and vomiting
B)Abdominal pain
C)Decreased bowel sounds
D)Shortness of breath

Accepted Answer

Adult respiratory distress syndrome is a grave complication of pancreatitis. All the other choices are manifestations of pancreatitis that the client may already be experiencing.

Question 7

Tuxen, a 66-year-old black American, was brought by his wife to the Emergency Department because he is increasingly confused and is coughing blood. His medical diagnosis is cirrhosis of the liver. While assessing Mr. Tuxen, the nurse understands that the correct technique when doing abdominal assessment is:

A)Palpate the most painful area progressing to the least painful parts
B)Begin with inspection and end with palpation
C)Follow the sequence of auscultation, inspection, percussion, and palpation
D)Auscultate the bowel sound first then perform palpation and percussion

Accepted Answer

The correct sequence when doing abdominal examination is inspection, auscultation, percussion, and palpation. The least invasive is done first and the most uncomfortable is done last.

Deck 3: Gastrointestinal