NSG 219 UPDATED KEY Questions And
CORRECT Answers
The nurse is caring for a patent with an indwelling urinary catheter. The nurse is aware that what nursing
action helps prevent infection in a patient with an indwelling urinary catheter?
A. Vigorously clean the meatus area daily.
B. Apply powder to the perineal area twice a day.
C. Empty the drainage bag at least every 8 hours.
D. Irrigate the catheter every 8 hours with normal saline. - CORRECT ANSWERS C. Empty the
drainage bag at least every 8 hours.
A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an
ileal conduit. The nurse is monitoring the patient's urine output hourly and notifies the physician when the
hourly output is less than what?
A 30 mL/hr
B. 50mL/hr
C. 100mL/hr
D. 125mL/hr - CORRECT ANSWERS A 30 mL/hr
After sleeve gastrectomy, a 42-yr-old male patient returns to the surgical nursing unit with a nasogastric
tube to low,
intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing
action should be included in the postoperative plan of care?
A. Support the surgical Incision during patient coughing and turning in bed.
B. Remind the patient that PCA use may slow the return of bowel function.
C. Offer sips of fruit juices at frequent intervals.
D. Irrigate the nasogastric (NG) tube frequently. - CORRECT ANSWERS A. Support the surgical
Incision during patient coughing and turning in bed.
The nurse will be teaching self-management to patients after gastric bypass surgery. Which information
will the nurse plan to include?
,A. Choose foods high in fiber to promote bowel function.
B. Developing flabby skin can be prevented by exercise.
C. Drink fluids between meals but not with meals.
D. Choose high-fat foods for at least 30% of intake. - CORRECT ANSWERS C. Drink fluids
between meals but not with meals.
Which action should the nurse in the emergency department anticipate for a young adult patient who has
had several acute episodes of bloody diarrhea?
A. Administer antidiarrheal medication.
B. Obtain a stool specimen for culture.
C. Teach the adverse effects of acetaminophen (Tylenol).
D. Provide teaching about antibiotic therapy. - CORRECT ANSWERS B. Obtain a stool specimen
for culture.
A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasing abdominal
pain. The patient has no bowel sounds and 200 ml of bright red nasogastric (NG) drainage in the past
hour. What is the highest priority action by the nurse?
A. Contact the surgeon.
B. Give prescribed morphine.
C. Monitor drainage.
D. Irrigate the NG tube. - CORRECT ANSWERS A. Contact the surgeon.
Which patient should the nurse assess first after receiving change-of-shift report?
A. A patient who is crying after receiving a diagnosis of esophageal cancer
B. A patient with esophageal varices who has a rapid heart rate
C. A patient with a history of gastrointestinal bleeding who has melena
D. A patient with nausea who has a dose of metoclopramide (Regian) due - CORRECT
ANSWERS B. A patient with esophageal varices who has a rapid heart rate
A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which
assessment finding is most important for the nurse to address immediately?
, A. The patient is experiencing intermittent waves of nausea.
B. The patient has no breath sounds in the left anterior chest.
C. The patient reports 7/10 (0 to 10 scale) abdominal pain.
D. The patent has hypoactive bowel sounds in all four quadrants - CORRECT ANSWERS B. The
patient has no breath sounds in the left anterior chest.
The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What Information is most
important to report to the health care provider?
A Absent bowel sounds in all quadrants
B. Scant nasogastric (NG) tube drainage
C. Temperature 102.1° F (38.9° C)
D. Hemoglobin (Hgb) 10.8 g/dL - CORRECT ANSWERS C. Temperature 102.1° F (38.9° C)
The nurse is performing a nutritional assessment on a newly admitted client with a diagnosis of recent
weight loss and malnutrition. Which finding is consistent with a diagnosis of malnutrition?
A. Moist skin
B. Muscle growth
C. Increase in subcutaneous fat
D. Decreased pigmentation of the hair - CORRECT ANSWERS D. Decreased pigmentation of the
hair
The nurse is caring for a client that is 24 hours post-operative colostomy. The nurse assess the client and
stoma site every 4 hours. Of the following descriptions, which indicates a normal stoma?
A. Stoma is pink, mildly swollen, scant amount of blood noted.
B. Stoma is red, swollen, and bleeding.
C. Stoma is pink, with a large amount of edema, scant amount of blood noted.
D. Stoma is dark red, no edema or bleeding noted. - CORRECT ANSWERS A. Stoma is pink,
mildly swollen, scant amount of blood noted.
CORRECT Answers
The nurse is caring for a patent with an indwelling urinary catheter. The nurse is aware that what nursing
action helps prevent infection in a patient with an indwelling urinary catheter?
A. Vigorously clean the meatus area daily.
B. Apply powder to the perineal area twice a day.
C. Empty the drainage bag at least every 8 hours.
D. Irrigate the catheter every 8 hours with normal saline. - CORRECT ANSWERS C. Empty the
drainage bag at least every 8 hours.
A patient with cancer of the bladder has just returned to the unit from the PACU after surgery to create an
ileal conduit. The nurse is monitoring the patient's urine output hourly and notifies the physician when the
hourly output is less than what?
A 30 mL/hr
B. 50mL/hr
C. 100mL/hr
D. 125mL/hr - CORRECT ANSWERS A 30 mL/hr
After sleeve gastrectomy, a 42-yr-old male patient returns to the surgical nursing unit with a nasogastric
tube to low,
intermittent suction and a patient-controlled analgesia (PCA) machine for pain control. Which nursing
action should be included in the postoperative plan of care?
A. Support the surgical Incision during patient coughing and turning in bed.
B. Remind the patient that PCA use may slow the return of bowel function.
C. Offer sips of fruit juices at frequent intervals.
D. Irrigate the nasogastric (NG) tube frequently. - CORRECT ANSWERS A. Support the surgical
Incision during patient coughing and turning in bed.
The nurse will be teaching self-management to patients after gastric bypass surgery. Which information
will the nurse plan to include?
,A. Choose foods high in fiber to promote bowel function.
B. Developing flabby skin can be prevented by exercise.
C. Drink fluids between meals but not with meals.
D. Choose high-fat foods for at least 30% of intake. - CORRECT ANSWERS C. Drink fluids
between meals but not with meals.
Which action should the nurse in the emergency department anticipate for a young adult patient who has
had several acute episodes of bloody diarrhea?
A. Administer antidiarrheal medication.
B. Obtain a stool specimen for culture.
C. Teach the adverse effects of acetaminophen (Tylenol).
D. Provide teaching about antibiotic therapy. - CORRECT ANSWERS B. Obtain a stool specimen
for culture.
A patient who underwent a gastroduodenostomy (Billroth I) 12 hours ago reports increasing abdominal
pain. The patient has no bowel sounds and 200 ml of bright red nasogastric (NG) drainage in the past
hour. What is the highest priority action by the nurse?
A. Contact the surgeon.
B. Give prescribed morphine.
C. Monitor drainage.
D. Irrigate the NG tube. - CORRECT ANSWERS A. Contact the surgeon.
Which patient should the nurse assess first after receiving change-of-shift report?
A. A patient who is crying after receiving a diagnosis of esophageal cancer
B. A patient with esophageal varices who has a rapid heart rate
C. A patient with a history of gastrointestinal bleeding who has melena
D. A patient with nausea who has a dose of metoclopramide (Regian) due - CORRECT
ANSWERS B. A patient with esophageal varices who has a rapid heart rate
A patient returned from a laparoscopic Nissen fundoplication for hiatal hernia 4 hours ago. Which
assessment finding is most important for the nurse to address immediately?
, A. The patient is experiencing intermittent waves of nausea.
B. The patient has no breath sounds in the left anterior chest.
C. The patient reports 7/10 (0 to 10 scale) abdominal pain.
D. The patent has hypoactive bowel sounds in all four quadrants - CORRECT ANSWERS B. The
patient has no breath sounds in the left anterior chest.
The nurse is assessing a patient who had a total gastrectomy 8 hours ago. What Information is most
important to report to the health care provider?
A Absent bowel sounds in all quadrants
B. Scant nasogastric (NG) tube drainage
C. Temperature 102.1° F (38.9° C)
D. Hemoglobin (Hgb) 10.8 g/dL - CORRECT ANSWERS C. Temperature 102.1° F (38.9° C)
The nurse is performing a nutritional assessment on a newly admitted client with a diagnosis of recent
weight loss and malnutrition. Which finding is consistent with a diagnosis of malnutrition?
A. Moist skin
B. Muscle growth
C. Increase in subcutaneous fat
D. Decreased pigmentation of the hair - CORRECT ANSWERS D. Decreased pigmentation of the
hair
The nurse is caring for a client that is 24 hours post-operative colostomy. The nurse assess the client and
stoma site every 4 hours. Of the following descriptions, which indicates a normal stoma?
A. Stoma is pink, mildly swollen, scant amount of blood noted.
B. Stoma is red, swollen, and bleeding.
C. Stoma is pink, with a large amount of edema, scant amount of blood noted.
D. Stoma is dark red, no edema or bleeding noted. - CORRECT ANSWERS A. Stoma is pink,
mildly swollen, scant amount of blood noted.
