Published - Thu, 23 Feb 2023

NCLEX-RN Exam Questions - Part 162

1. A client develops an intestinal obstruction postoperatively. A nasogastric tube is attached to low, intermittent suction with orders to 'Irrigate NG tube with sterile saline q1h and prn.' The rationale for using sterile saline, as opposed to using sterile water to irrigate the NG tube is:

A) Water will deplete electrolytes resulting in metabolic acidosis.
B) Saline will reduce the risk of severe, colicky abdominal pain during NG irrigation.
C) Water is not isotonic and will increase restlessness and insomnia in the immediate postoperative period.
D) Saline will increase peristalsis in the bowel.

2. A 35-year-old client has returned to her room following surgery on her right femur. She has an IV of D5 in onehalf normal saline infusing at 125 mL/hr and is receiving morphine sulfate 1015 mg IM q4h prn for pain. She last voided 51/2 hours ago when she was given her preoperative medication. In monitoring and promoting return of urinary function after surgery, the nurse would:

A) Provide food and fluids at the client - s request
B) Maintain IV, increasing the rate hourly until the client voids
C) Report to the surgeon if the client is unable to void within 8 hours of surgery
D) Hold morphine sulfate injections for pain until the client voids, explaining to her that morphine sulfate can cause urinary retention

3. A 47-year-old male client is admitted for colon surgery. Intravenous antibiotics are begun 2 hours prior to surgery. He has no known infection. The rationale for giving antibiotics prior to surgery is to:

A) Provide cathartic action within the colon
B) Reduce the risk of wound infection from anaerobic bacteria
C) Relieve the client - s concern regarding possible infection
D) Reduce the risk of intraoperative fever

4. A 19-month-old child is admitted to the hospital for surgical repair of patent ductus arteriosus. The child is being given digoxin. Prior to administering the medication, the nurse should:

A) Not give the digoxin if the pulse is_60
B) Not give the digoxin if the pulse is_100
C) Take the apical pulse for a full minute
D) Monitor for visual disturbances, a side effect of digoxin

5. The family member of a child scheduled for heart surgery states, 'I just don - t understand this open-heart or closed-heart business. I - m so confused! Can you help me understand it?' The nurse explains that patent ductus arteriosus repair is:

A) Open-heart surgery. The child will be placed on a heart-lung machine while the surgery is being performed.
B) Closed-heart surgery. It does not require that the child be placed on the heart-lung machine while the surgery is being performed.
C) A pediatric version of the coronary artery bypass graft surgery performed on adults. It is an open-heart surgery.
D) A pediatric version of percutaneous transluminal coronary angioplasty performed on adults. It is a closed-heart surgery.

1. Right Answer: A
Explanation: (A) Water is a hypotonic solution and will deplete electrolytes and cause metabolic acidosis when used for nasogastric irrigation. (B) Irrigating with saline does not cause abdominal discomfort. Severe, colicky abdominal pain is a symptom of intestinal obstruction. (C) Irrigating with water will not cause restlessness or insomnia in the postoperative client. Restlessness and insomnia can be emotional complications of surgery. (D) A nasogastric tube placed in the stomach is used to decompress the bowel. Irrigating with saline ensures a patent, well-functioning tube. Irrigating with saline will not increase peristalsis.

2. Right Answer: C
Explanation: (A) Provision of food and fluid promotes bowel elimination. Nutritional needs postoperatively are determined by the physician, not the client. (B) Increasing IV fluids postoperatively will not cause a client to void. Any change in rate of administration of IV fluids should be determined by the physician. (C) The postoperative client with normal kidney function who cannot void 8 hours after surgery is retaining urine. The client may need catheterization or medication. The physician must provide orders for both as necessary. (D) Although morphine sulfate can cause urinary retention, withholding pain medication will not ensure that the client will void. The client with uncontrolled pain will probably not be able to void.

3. Right Answer: B
Explanation: (A) Cathartic drugs promote evacuation of intestinal contents. (B) The client undergoing intestinal surgery is at increased risk for infection from large numbers of anaerobic bacteria that inhabit the intestines. Administering antibiotics prophylactically can reduce the clients risk for infection. (C) Antibiotics are indicated in the treatment of infections and have no effect on emotions. (D) Antipyretics are useful in the treatment of elevated temperatures. Antibiotics would have an effect on infection, which causes temperature elevation, but would not directly affect such an elevation.

4. Right Answer: C
Explanation: (A) Digoxin should not be given to adults with an apical pulse < 60 bpm. (B) Digoxin should be given to children with an apical pulse > 100 bpm. With a pulse <100 bpm, the medication should be withheld and the physician notified. (C) Prior to digoxin administration in both children and adults, an apical pulse should be taken for 1 full minute. Aside from the rate per minute, the nurse should note any sudden increase or decrease in heart rate, irregular rhythm, or regularization of a chronic irregular heart rhythm. (D) Early indications of digoxin toxicity, such as visual disturbances, occur rarely as initial signs in children.

5. Right Answer: B
Explanation: (A) Patent ductus arteriosus repair is a closed-heart procedure. The client is not placed on a heart-lung machine. (B) Patent ductus arteriosus is a ductus arteriosus that does not close shortlyafter birth but remains patent. Repair is a closed-heart procedure involving ligation of the patent ductus arteriosus. (C)Coronary artery bypass graft surgery is an open-heart surgical procedure in which blocked coronary arteries are bypassed using vessel grafts. (D) Percutaneous transluminal coronary angioplasty is a closedheart procedure that improves coronary blood flow by increasing the lumen size of narrowed vessels.

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