A nurse is teaching a client who is preoperative for a colectomy. The client asks the nurse why he needs a large-bore NG tube. Which of the following statements should the nurse make?

The tube is a routine standard following this type of surgery.

The tube will allow us to provide you with nutrition.

The tube can be explained to you once you are stable after surgery.

The tube will remove gas and fluid from your stomach.

Answer and Explanation

The Correct Answer is D

Choice A reason: The statement that the tube is a routine standard following this type of surgery is too vague and does not provide the client with specific information about the purpose of the NG tube. Providing clear and specific reasons for medical interventions helps improve client understanding and comfort.
Choice B reason: While NG tubes can be used for nutritional support, this is not typically their primary purpose in the immediate postoperative period for colectomy patients. The main purpose is usually decompression, not nutrition.
Choice C reason: Telling the client that the tube can be explained once they are stable after surgery does not adequately address the client's need for information before the procedure. It is essential to provide clear and accurate information beforehand to reduce anxiety and promote informed consent.
Choice D reason: This is the correct answer because it clearly explains the primary purpose of a large-bore NG tube after a colectomy, which is to remove gas and fluid from the stomach to prevent distension and complications such as nausea, vomiting, and aspiration.

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Correct Answer is D

Explanation

Choice A reason: Spironolactone is a potassium-sparing diuretic, so it is more likely to cause elevated potassium levels rather than decreased levels.
Choice B reason: Chloride levels are not typically affected in a predictable pattern with the use of spironolactone or in liver failure with ascites.
Choice C reason: Phosphate levels are not commonly altered by spironolactone or in ascites, and any changes would depend on other metabolic factors.
Choice D reason: Spironolactone can lead to decreased sodium levels due to its action as a diuretic that promotes sodium excretion while retaining potassium. This is particularly relevant in clients with liver failure and ascites, where fluid and electrolyte management is crucial.

A. Mr. Smith, who has multiple sclerosis, has been managing his urinary retention with intermittent catheterization for several years. He has been depressed lately after losing his job and admitted at his last visit to having thoughts of self-harm. He left a message saying he had chills, fatigue, and an oral temperature of 103°F. B. Ms. Jones, who has had urinary frequency and urgency for many years, started on Ditropan at her last office visit. She left a message saying her urinary frequency has improved, but her mouth was very dry. C. Mr. Jones, a new patient expressing concerns over embarrassing symptoms of incontinence. D. Ms. Smith, who is 18 years old, called to cancel her afternoon appointment for her initial incontinence evaluation. Her message said her symptoms weren't that bad and she would call to reschedule.

Correct Answer is A

Explanation

Choice A reason: Mr. Smith requires immediate attention due to his multiple sclerosis and severe symptoms of chills, fatigue, and a high fever (103°F). These symptoms could indicate a severe infection such as a urinary tract infection (UTI) or even sepsis, which can be life-threatening, especially in individuals with a compromised immune system or chronic conditions like multiple sclerosis.
Choice B reason: Ms. Jones's dry mouth is a common side effect of Ditropan (oxybutynin), which is used to treat urinary frequency and urgency. While it is uncomfortable, it is not an emergency and can be addressed at the next visit or over a phone consultation.
Choice C reason: Mr. Jones, being a new patient with incontinence concerns, does not present an immediate emergency. This issue, while significant for his quality of life, can be managed through a scheduled appointment.
Choice D reason: Ms. Smith's decision to cancel her appointment due to her symptoms not being severe does not require immediate attention. She can be rescheduled for a later date without risk to her health.

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A nurse is teaching a client who is preoperative for a colectomy. The client asks the nurse why he needs a large-bore NG tube. Which of the following statements should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

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Correct Answer is A

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