NLE Practice Test 3a - Pt. 5 - Quiz, Flashcards & Trivia

1. The nurse tells Mr. Mangoni that the nasogastric tube will be removed:

Standardly on the fourth postoperative day.

When bowel sounds are established and the client has passed flatus or Stool

Thirty-six hours after the cessation of bloody drainage.

After 2 days of alternate clamping and unclamping of the tube.

The nurse tells Mr. Mangoni that the nasogastric tube will be removed when bowel sounds are established and the client has passed flatus or stool. This is the correct answer because the return of bowel sounds and the ability to pass flatus or stool indicate that the gastrointestinal tract is functioning properly and that the need for the nasogastric tube has diminished. Removing the tube at this point is safe and appropriate for the client's recovery.

Explanation

The nurse tells Mr. Mangoni that the nasogastric tube will be removed when bowel sounds are established and the client has passed flatus or stool. This is the correct answer because the return of bowel sounds and the ability to pass flatus or stool indicate that the gastrointestinal tract is functioning properly and that the need for the nasogastric tube has diminished. Removing the tube at this point is safe and appropriate for the client's recovery.

2. The nurse must observe for which of the following imbalances to occur with prolonged nasogastric suctioning?

Hypernatremia

Hyperkalemia

Metabolic alkalosis

Hypoproteinemia

Prolonged nasogastric suctioning can lead to metabolic alkalosis. This occurs because the continuous suctioning removes gastric acid, leading to a decrease in hydrogen ions. As a result, there is an increase in bicarbonate levels, causing the blood pH to rise and become more alkaline. This imbalance can disrupt the body's acid-base balance and lead to symptoms such as muscle twitching, confusion, and weakness.

Explanation

Prolonged nasogastric suctioning can lead to metabolic alkalosis. This occurs because the continuous suctioning removes gastric acid, leading to a decrease in hydrogen ions. As a result, there is an increase in bicarbonate levels, causing the blood pH to rise and become more alkaline. This imbalance can disrupt the body's acid-base balance and lead to symptoms such as muscle twitching, confusion, and weakness.

3. The nurse will usually ambulate the post gastrectomy patient beginning;

The day after surgery

Three to four days after surgery

After 4 days bedrest

Immediately upon awakening .

The nurse will usually ambulate the post gastrectomy patient beginning the day after surgery. This is because early ambulation helps prevent complications such as blood clots, pneumonia, and muscle weakness. It also promotes faster recovery and improves overall patient outcomes. Delaying ambulation for too long can lead to complications and hinder the patient's recovery process. Therefore, starting ambulation the day after surgery is the most appropriate and beneficial approach.

Explanation

The nurse will usually ambulate the post gastrectomy patient beginning the day after surgery. This is because early ambulation helps prevent complications such as blood clots, pneumonia, and muscle weakness. It also promotes faster recovery and improves overall patient outcomes. Delaying ambulation for too long can lead to complications and hinder the patient's recovery process. Therefore, starting ambulation the day after surgery is the most appropriate and beneficial approach.

4. Which of the following statements would the nurse include in teaching regarding nasogastric tubes?

Nasogastric tubes should be irrigated with sterile water.

Client should be in sitting position with head slightly flexed for tube Insertion

Ice chips- can be taken as often as desired to promote comfort in thethroat.

The nurse should include in teaching that the client should be in a sitting position with the head slightly flexed for tube insertion. This position helps to facilitate the insertion of the nasogastric tube and reduces the risk of complications.

Explanation

The nurse should include in teaching that the client should be in a sitting position with the head slightly flexed for tube insertion. This position helps to facilitate the insertion of the nasogastric tube and reduces the risk of complications.

5. Which of the following nursing interventions would be included. in the preoperative period for Mr. Mangoni?

Insertion of a nasogastric tube on the morning of surgery.

Administration of Vallum 4 mg with 4 oz water 1 hour before surgery.

Detailed description of the possible complications that could happen postoperatively

Instructions to avoid taking pain medication too frequently in the first 2 postoperative days to avoid drug dependency.

The insertion of a nasogastric tube on the morning of surgery is a nursing intervention that would be included in the preoperative period for Mr. Mangoni. This intervention is commonly done to decompress the stomach and prevent aspiration during surgery. It helps to empty the stomach contents and reduce the risk of vomiting and aspiration of gastric contents into the lungs during anesthesia.

Explanation

The insertion of a nasogastric tube on the morning of surgery is a nursing intervention that would be included in the preoperative period for Mr. Mangoni. This intervention is commonly done to decompress the stomach and prevent aspiration during surgery. It helps to empty the stomach contents and reduce the risk of vomiting and aspiration of gastric contents into the lungs during anesthesia.

6. The nurse would recognize drainage from the nasogastric tube after surgery as abnormal If:

It after 6 hours

It continued for a period greater than 12 hours.

Ft turned greenish yeiiow in less than 24 hours.

It was dark red in the immediate postoperative period.

The nurse would recognize drainage from the nasogastric tube after surgery as abnormal if it continued for a period greater than 12 hours. This is because drainage from the nasogastric tube is expected in the immediate postoperative period, but it should decrease and eventually stop within 12 hours. If the drainage continues for a longer period, it may indicate a complication or issue that needs to be addressed by the healthcare team.

Explanation

The nurse would recognize drainage from the nasogastric tube after surgery as abnormal if it continued for a period greater than 12 hours. This is because drainage from the nasogastric tube is expected in the immediate postoperative period, but it should decrease and eventually stop within 12 hours. If the drainage continues for a longer period, it may indicate a complication or issue that needs to be addressed by the healthcare team.

7. Mr. Mangoni asks why the vagotomy is being done. You explain that a vagotomy is done in conjunction with a subtotal gastrectomy because the vagus nerve:

Stimulates increased gastric motility.

Decreases gastric motiiity, thereby preventing the movement of HCl out of the stomach.

Stimulates both increased gastric secretion and gastric motiiity.

Stimulates decreased gastric secretion, thereby increasing nausea and vomiting.

A vagotomy is done in conjunction with a subtotal gastrectomy because the vagus nerve stimulates both increased gastric secretion and gastric motility. By cutting the vagus nerve, the stimulation is decreased, which helps in reducing the secretion of gastric acid and preventing excessive movement of the stomach. This is important in managing conditions such as ulcers or gastric hypersecretion.

Explanation

A vagotomy is done in conjunction with a subtotal gastrectomy because the vagus nerve stimulates both increased gastric secretion and gastric motility. By cutting the vagus nerve, the stimulation is decreased, which helps in reducing the secretion of gastric acid and preventing excessive movement of the stomach. This is important in managing conditions such as ulcers or gastric hypersecretion.

8. Of the following mouth care measures by the nurse, which one should be used with caution when a client has a nasogastric tube?

Regularly brushing teeth and tongue with soft brush.

Sucking on ice chips to relieve dryness.

Occasionally rinsing mouth with a nonastringent substance and massaging gums.

Application of lemon juice and glycerine swabs to the lips.

Sucking on ice chips to relieve dryness should be used with caution when a client has a nasogastric tube because it can increase the risk of aspiration. The nasogastric tube bypasses the natural defense mechanisms of the mouth and throat, making it easier for substances to enter the lungs. Therefore, sucking on ice chips can potentially lead to choking or aspiration pneumonia in clients with a nasogastric tube.

Explanation

Sucking on ice chips to relieve dryness should be used with caution when a client has a nasogastric tube because it can increase the risk of aspiration. The nasogastric tube bypasses the natural defense mechanisms of the mouth and throat, making it easier for substances to enter the lungs. Therefore, sucking on ice chips can potentially lead to choking or aspiration pneumonia in clients with a nasogastric tube.

9. Which of the following complications, would you primarily anticipate in Mr. Mangoni's postoperative period?

Thrombophlebitis from decreased mobility.

Abdominal distention due to air swallowing

Atelectasis due to shallow breathing

Urinary retention due to prolonged use of antichoiinergic medications.

In Mr. Mangoni's postoperative period, the primary complication that can be anticipated is atelectasis due to shallow breathing. Atelectasis refers to the collapse or partial collapse of the lung tissue, which can occur when there is inadequate deep breathing or coughing. Shallow breathing can lead to reduced lung expansion and ventilation, causing the alveoli to collapse and impairing gas exchange. This complication is commonly seen after surgery, especially abdominal surgery, as pain and discomfort can discourage patients from taking deep breaths. Prompt intervention and encouragement of deep breathing exercises can help prevent and manage atelectasis in the postoperative period.

Explanation

In Mr. Mangoni's postoperative period, the primary complication that can be anticipated is atelectasis due to shallow breathing. Atelectasis refers to the collapse or partial collapse of the lung tissue, which can occur when there is inadequate deep breathing or coughing. Shallow breathing can lead to reduced lung expansion and ventilation, causing the alveoli to collapse and impairing gas exchange. This complication is commonly seen after surgery, especially abdominal surgery, as pain and discomfort can discourage patients from taking deep breaths. Prompt intervention and encouragement of deep breathing exercises can help prevent and manage atelectasis in the postoperative period.

10. Following surgery the nurse must observe for signs of pernicious anemia, which may be a problem after gastrectomy because:

The extrinsic factor is produced In the stomach.

The extrinsic factor is absorbed in the antral portion of the stomach.

The intrinsic factor Is produced in the stomach.

Decreased hydrochloric acid production Inhibits vitamin B12 reabsorption.

After a gastrectomy, the stomach is either partially or completely removed. The intrinsic factor, which is necessary for the absorption of vitamin B12, is produced in the stomach. Without the stomach, the production of intrinsic factor is impaired, leading to a potential deficiency in vitamin B12 absorption. This deficiency can result in pernicious anemia. Therefore, it is important for the nurse to observe for signs of pernicious anemia in patients who have undergone gastrectomy.

Explanation

After a gastrectomy, the stomach is either partially or completely removed. The intrinsic factor, which is necessary for the absorption of vitamin B12, is produced in the stomach. Without the stomach, the production of intrinsic factor is impaired, leading to a potential deficiency in vitamin B12 absorption. This deficiency can result in pernicious anemia. Therefore, it is important for the nurse to observe for signs of pernicious anemia in patients who have undergone gastrectomy.