VCE

I have 4th edition. It's patients are Harry George,Piya Jordan, & Pablo Rodriguez. If you have the same I got the help you need.

Does anyone have any help for the VCE's for Med surg and Pediactrics? Spending hours doing these and not studying for lecture test.....please help.

Best if you post the question you're having troubles with.

i have med surg VCE's answer key

can anyone tell me a website that has a VCE answer key and isn't a malware scam?

Malware scam?

Yes when I try to download the answer key on about every website that I have tried it usually sends me to a spam page and isn't actually the answer key

Is there a way i could get that? I need
Piya Jordan Question Pool
Thank you

Piya Jordan Question Pool Answers

1. Piya Jordan, a 68-year-old preoperative client with suspected bowel obstruction, asks why her dose of warfarin (Coumadin) has been ordered withheld. Which of the following responses by the nurse is most accurate?
•    "This medication could cause excessive bleeding during surgery if it is not stopped beforehand." Correct
•    "All unnecessary medications are stopped before surgery."
•    "This medication could have dangerous drug interactions with the anesthesia you will receive during surgery."
•    "This medication could worsen fluid and electrolyte balance and needs to be stopped for a few days until any acid-base imbalance clears."
Coumadin is an anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected before surgery. For this reason, the client's clotting parameters are monitored as a means of ensuring that the effects of the medication are reversed.
2. Which of the following manifestations, if exhibited by Ms. Jordan, would the nurse attribute to adverse effects of morphine sulfate administered by way of patient-controlled analgesia?
•    Diarrhea
•    Nausea and vomiting Correct
•    Increased blood pressure
•    Urinary incontinence
Morphine sulfate promotes nausea and vomiting by directly stimulating the chemoreceptor-trigger zone in the medulla.

3. When administering a dose of ondansetron (Zofran) to Ms. Jordan, the nurse would teach the client to report which of the following common adverse effects?
•    Constipation
•    Numbness in the fingers and toes
•    Headache Correct
•    Double vision
Headache that is severe enough to require an analgesic medication is a common adverse effect of ondansetron. The client should be taught to report this symptom to the nurse.

4.  Ms. Jordan can receive acetaminophen 650 mg per rectum every 6 hours as needed for fever greater than 102º F. The nurse would do which of the following to administer this drug?
•    Position the client on the left side for administration. Correct
•    Lubricate the suppository with petrolatum jelly.
•    Insert the suppository into the anus just until it disappears.
•    Wear sterile gloves for the administration.
Because of the curvature of the large bowel, the client should be positioned on the left side for administration of the suppository. This will help prevent it from being expelled from the rectum as readily.

5. Ms. Jordan has a one-time order for potassium chloride 20 mEq in 250 mL of normal saline IV to be given immediately. The nurse concludes that which of the following serum potassium levels best supports the rationale for this order?
•    3.1 mEq/L Correct
•    3.9 mEq/L
•    4.6 mEq/L
•    5.3 mEq/L
The normal range for serum potassium is 3.6 to 5.1 mEq/L. The change in IV order provides a substantial amount of potassium, so the client's potassium level must be low. The lowest value shown is 3.1 mEq/L.

6. The nurse is administering a dose of digoxin (Lanoxin) to Ms. Jordan. The nurse would become concerned with the possibility of digitalis toxicity if the client reported which of the following symptoms?
•    Muscle aches
•    Constipation
•    Anorexia and nausea Correct
•    Pounding headache
Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the prescriber if the client exhibited any of these symptoms.

7 Ms. Jordan asks for an explanation of why she is receiving cefotetan (Cefotan). The nurse replies that the medication is being administered for which of the following reasons?
•    Prevent postoperative surgical-site infection. Correct
•    Protect against urinary-tract infection.
•    Prevent postoperative pneumonia.
•    Treat a preexisting respiratory infection.
Cefotetan has enhanced activity against a wide variety of Gram-negative organisms and is being used for perioperative prophylaxis against infection at the surgical site. The bowel has a wide variety of bacterial flora that could contaminate the abdominal cavity during surgery.

8. The nurse would determine that Ms. Jordan is not receiving the beneficial effects of enoxaparin (Lovenox) after noting which of the following during a routine shift assessment?
•    Generalized weakness
•    Abdominal pain
•    Crackles bilaterally in the lung bases
•    Homans' sign Correct
Enoxaparin is a low-molecular-weight heparin used to prevent the development of deep-vein thromboses in the postoperative period. Homans' sign (pain in the calf on dorsiflexion of the foot) can indicate development of deep-vein thrombosis and may signal ineffective medication therapy.

9. Ms. Jordan states that she has never taken famotidine (Pepcid) in the past, although she has heard of it on television commercials. She asks why she is getting this medication if she has never had heartburn. Which of the following replies by the nurse would be best?
•    "The stress of surgery is likely to cause stomach bleeding if you do not receive it."
•    "This will reduce the amount of hydrochloric acid in the stomach until the nasogastric tube is removed and you can eat a regular diet again." Correct
•    "This will prevent air from accumulating in the stomach, causing gas pains."
•    "This will prevent the heartburn that occurs as a side effect of general anesthesia."
Famotidine is an H2-receptor antagonist that inhibits pentagastrin-stimulated gastric secretions. It reduces parietal-cell output of hydrochloric acid and minimizes damage to the gastric mucosa while the client is not taking a diet after surgery.

10. After administering a dose of promethazine (Phenergan) to Ms. Jordan, the nurse explains that which of the following may be experienced as a common temporary adverse effect of the medication?
•    Photosensitivity
•    Drowsiness Correct
•    Sensation of falling
•    Reduced hearing
Although being given to this client as an antiemetic, promethazine also has sedative and amnesic properties. For this reason, the client is likely to experience drowsiness as an adverse effect of the medication.

11. Ms. Jordan is being changed from patient-controlled analgesia with meperidine (Demerol) to morphine sulfate after experiencing restlessness and agitation. Her daughter asks why the change has been made. Which of the following replies by the nurse is most appropriate?
•    "Meperidine is not controlling the surgical pain effectively."
•    "Meperidine can only be used for 24 hours after surger."
•    "Your mother's respiratory rate has dropped too low, and this is affecting her mental status."
•    "Your mother is experiencing toxic effects of meperidine." Correct
Confusion, restlessness, and agitation are signs of toxicity from normeperidine, a toxic metabolite of meperidine.

12.The nurse reads the following order on Tuesday morning: "Infuse 1 unit of fresh frozen plasma on call to the OR." To complete this order safely, the nurse should take which of the following actions?
•    Hang the fresh frozen plasma as a piggyback to a primary solution of normal saline solution.
•    Hang the fresh frozen plasma as a piggyback to a new bag of primary IV solution that does not have KCl added.
•    Hang the fresh frozen plasma as a piggyback to the primary IV solution.
•    Infuse the fresh frozen plasma as rapidly as the client will tolerate. Correct
The fresh frozen plasma should be administered as rapidly as possible and should be used within 6 hours. Fresh frozen plasma is infused with the use of any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infusing, unless a second IV line has been started for the transfusion.

13. The nurse has an order to give famotidine (Pepcid) 20 mg by the IV push route. To administer this drug safely, the nurse should give this medication over a minimum of how many minutes?
•    10 minutes
•    5 minutes
•    2 minutes Correct
•    1 minute
The nurse should give the IV push medication over a minimum of 2 minutes to administer it safely.

14. Before giving the first dose of cefotetan to Ms. Jordan, the nurse would question the order if the client stated an allergy to which of the following medications?
•    Caspofungin (Cancidas)
•    Cetirizine (Zyrtec)
•    Celecoxib (Celebrex)
•    Cephapirin (Cefadyl) Correct
Cephapirin is a first-generation cephalosporin-type antibiotic; cefotetan is a second-generation cephalosporin. A client who is allergic to one of these may be allergic to the other, and it is prudent for client safety to question the order.

15. Ms. Jordan is scheduled to receive a dose of digoxin (Lanoxin). The morning laboratory results are as follows: sodium 139 mEq/L, potassium 3.0 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. The nurse should do which of the following at this time?
•    Withhold the dose and report the potassium level. Correct
•    Give the digoxin with extra fluids to dilute the sodium level.
•    Give the digoxin with a salty snack, such as crackers.
•    Withhold the daily dose until the next day.
The normal potassium level is 3.5 to 5.1 mEq/L. The client is hypokalemic, which makes her more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and increased to the normal range.

16. The nurse is reviewing the laboratory results for Ms. Jordan before administering the ordered dose of vitamin K1 (Phytonadione). The nurse determines that the medication is both safe to give and is most needed when the international normalized ratio (INR) is which of the following?
•    1.0
•    1.2
•    2.1 Correct
•    1.6
Phytonadione is the antidote to sodium warfarin (Coumadin), which the client had been taking before admission. Coumadin is an anticoagulant that impairs the ability of the blood to clot. It is necessary to give phytonadione before surgery to reduce the risk of hemorrhage. The greatest value of the INR indicates the greatest impairment of clotting ability, making 2.1 the correct selection.

17. Ms. Jordan is scheduled to receive the first dose of enoxaparin (Lovenox). For proper administration, which of the following sites should the nurse select for injection, provided that it is not close to skin lesions, scars, or incisions?
•    Back of the arm
•    Buttock
•    Thigh
•    Abdomen Correct
Enoxaparin (Lovenox) is a low-molecular-weight heparin that is given as a subcutaneous injection. The preferred injection site for this medication is the right and left anterolateral abdominal wall.

18. Ms. Jordan is able to receive meperidine (Demerol) 10 mg every 10 minutes by patient-controlled analgesia (PCA) pump. The nurse should take action as soon as Ms. Jordan's respirations drop to which of the following rates, accompanied by an oxygen saturation of 88%?
•    14 breaths/minute
•    10 breaths/minute Correct
•    8 breaths/minute
•    6 breaths/minute
To protect the client from the adverse effects of respiratory depression caused by this medication, the nurse should alert the physician as soon as the respiratory rate drops to or below 12 breaths per minute.

19. Ms. Jordan has a new order to be transfused with 2 units of packed red blood cells (PRBCs). The nurse should take which of the following actions to avoid an error during this procedure?
•    Select a new primary IV tubing to use for the administration.
•    Remain with Ms. Jordan for 60 minutes after beginning the transfusion to watch for signs of transfusion reaction.
•    Add the blood transfusion as a secondary line to the existing IV.
•    Have a second registered nurse check the identifying information on the unit of blood against Ms. Jordan's identification bracelet and blood-bank identification bracelet. Correct
The client's identifying information (name, date of birth, medical record number) on the identification bracelet should exactly match the information on the blood-bank tag that has been placed on the unit of blood. If any information does not match, the transfusion should not be hung because of possible error and risk to the client.

20. Ms. Jordan has an order to receive meperidine (Demerol) 50–75 mg IVP q3–4h PRN for pain. On hand are prefilled syringes labeled "100 mg/mL." How many milliliters should the nurse administer to give a 75-mg dose?
•    1 mL
•    2 mL
•    0.5 mL
•    0.75 mL Correct
21. Ms. Jordan is nauseated and can have promethazine 12.5–25 mg IV push q4–6h PRN for nausea. On hand is a vial labeled "50 mg/mL." How many milliliters should the nurse administer to give a 25-mg dose?
•    5 mL
•    0.5 mL Correct
•    1 mL
•    0.25 mL

22. Ms. Jordan has an order to receive famotidine (Pepcid) 20 mg IVPB or IVP q12h. Available is a vial containing 10 mg/mL. How many milliliters should the nurse draw up to administer this dose?
•    2 mL Correct
•    5 mL
•    0.2 mL
•    0.5 mL
23. Ms. Jordan is due for a first dose of digoxin (Lanoxin) 0.125 mg IV push on Wednesday morning. Available is a vial containing 0.25 mg/mL. How many milliliters should the nurse draw up to administer the dose?
•    1.0 mL
•    1.25 mL
•    0.5 mL Correct
•    0.6 mL
24. Ms. Jordan has an order for cefotetan (Cefotan) 1 g IVPB q12h for 6 doses. Available is a vial filled with 1 g of cefotetan powder. The instructions state to "dilute each 1 g with 10 mL of sterile water." After reconstituting the medication, how many milliliters of solution should the nurse draw up for dosage preparation?
•    0.1 mL
•    10 mL Correct
•    1.0 mL
•    2.1 mL
25 The IV order for Ms. Jordan reads "D5.45 NS with 40 mEq KCl/L at 125 mL/hour." The nurse needs to add KCl to the IV because no premixed solutions are available. The unit's medication supply has a stock of KCl 3 mEq/mL in multidose vials. How many total milliliters does the nurse need to draw up to add to the IV solution?
•    15 mL
•    7.5 mL
•    10 mL
•    13.3 mL Correct
26. Piya Jordan is a 68-year-old client admitted with abdominal pain, nausea, and vomiting. She has an abdominal mass, and a bowel obstruction is suspected. The nurse, auscultating the abdomen, listens for which of the following types of bowel sounds that is consistent with the client's clinical picture?
•    High-pitched and hypoactive, below the area of obstruction
•    Low-pitched and rumbling, above the area of obstruction
•    Low-pitched and hyperactive, below the area of obstruction
•    High-pitched and hyperactive, above the area of obstruction Correct
Early in the course of intestinal obstruction, the client's bowel sounds are hyperactive and high-pitched, sometimes referred to as "tinkling," above the level of the obstruction. This occurs because peristaltic action increases to "push past" the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally disappear.

27. Piya Jordan is a 68-year-old client with an abdominal mass and suspected bowel obstruction. Which of the following factors in the client's history places her at greatest risk for colorectal cancer?
•    History of rectal polyps Correct
•    Use of herbs as dietary supplements
•    Osteoarthritis
•    History of lactose intolerance
A history of rectal polyps places this client at risk for colorectal cancer. This tissue can degenerate over time and become malignant. The other factors identified do not pose additional risks to the client.

28. Piya Jordan is a 68-year-old client with an abdominal mass and suspected bowel obstruction. The client asks the nurse why a nasogastric tube is going to be inserted. Which of the following responses is most appropriate?
•    "The tube will help to drain the stomach contents and prevent further vomiting." Correct
•    "The tube will let us measure your stomach contents, so that we can plan what type of IV fluid replacement would be best."
•    "The tube will push past the area that is blocked and help stop the vomiting."
•    "The tube is just a standard procedure before many types of surgery to the abdomen."
The nasogastric tube is used to decompress the stomach by draining stomach contents and thereby prevent further vomiting.

29. Piya Jordan, a 68-year-old client with suspected bowel obstruction, has had a nasogastric tube inserted at 04:00. The nurse shares in intershift report that the day-shift staff should check the tube routinely at which of the following times?
•    08:00 and 12:00 Correct
•    09:00, 12:00, and 15:00
•    09:00 and 15:00
•    07:00, 10:00, and 13:00
A nasogastric tube should be checked routinely at 4-hour intervals. Therefore, if the tube were inserted at 04:00, it would be due to be checked at 08:00 and 12:00.

30. The nurse who inserted a nasogastric tube for Piya Jordan, a 68-year-old client with suspected bowel obstruction, should write which of the following priority nursing diagnoses on the client's problem list?
•    Abdominal pain related to nasogastric-tube placement
•    Risk for oral altered mucous membrane related to nasogastric-tube placement Correct
•    Anxiety related to nasogastric-tube placement
•    Risk for deficient knowledge related to nasogastric-tube placement
With nasogastric-tube placement, the client is likely to breathe through the mouth and may experience irritation in the affected nares. For this reason, the nurse should plan preventive measures, using this nursing diagnosis.

31. Piya Jordan is a 68-year-old client admitted with abdominal pain and nausea and vomiting. She has an abdominal mass, and a bowel obstruction is suspected. The nurse assesses this client for which of the following anticipated primary acid-base imbalances if the obstruction is high in the intestine?
•    Respiratory alkalosis
•    Respiratory acidosis
•    Metabolic alkalosis Correct
•    Metabolic acidosis
Because gastric secretions are rich in hydrochloric acid, the client who is vomiting will lose significant amounts of gastric acid and is at increased risk for metabolic alkalosis.

32 Piya Jordan has been receiving warfarin (Coumadin) and digoxin (Lanoxin) as treatment for atrial fibrillation. Because the Coumadin has been discontinued before surgery, the nurse should diligently assess the client for which complication early in the postoperative period until the medication is resumed?
•    Increased blood pressure
•    Excessive bleeding from incision or IV puncture sites
•    Decreased cardiac output
•    Arterial or pulmonary emboli Correct
Coumadin is an anticoagulant that is used to prevent mural thrombi from forming on the walls of the atria during atrial fibrillation. Once the medication is terminated, thrombi could again form. If one or more detach from the atrial wall, they could travel as arterial emboli from the left atrium or as pulmonary emboli from the right atrium.

33. The nurse is reviewing the laboratory test results for Piya Jordan, a 68-year-old client whose warfarin (Coumadin) therapy was terminated during the preoperative period. The nurse concludes that the client is in most stable condition for surgery after noting which of the following INR (international normalized ratio) results?
•    2.7
•    3.4
•    1.8
•    1.0 Correct
The therapeutic range for INR is 2.0 to 3.0 for many clinical diagnoses. The larger the number, the greater the amount of anticoagulation. For this reason, the safest value before surgery is 1.0, meaning that the anticoagulation has been reversed

34. Piya Jordan is a 68-year-old woman who has osteoarthritis of the knees. Which of the following findings would the nurse expect to be present on examination of the client's knees?
•    Pain upon joint movement Correct
•    Swan-neck deformity in affected joints
•    Reddened, swollen affected joints
•    Stiffness that increases with movement
Osteoarthritis is characterized predominantly by joint pain on movement.

35. Piya Jordan, a 68-year-old woman, has bilateral osteoarthritis of the knees. The nurse teaches the client that the most beneficial measure to protect the joints is to do which of the following?
•    Use a wheelchair to avoid walking as much as possible.
•    Regulate the diet to maintain a healthy body weight. Correct
•    Sit in chairs that do not cause her hips to be lower than her knees.
•    Use a walker for ambulation to relieve the pressure on her hips.
Because maintaining an appropriate load on the joints is essential to the preservation of articular cartilage integrity, the client should maintain an optimal overall body weight or lose weight if overweight.

36. The nurse is reinforcing general health teaching with Piya Jordan, a 68-year-old client with osteoarthritis of the knees. Which of the following points would the nurse include in this review of the disorder?
•    Osteoarthritis is more common with aging, but usually it remains confined to a few joints and does not cause crippling. Correct
•    Osteoarthritis can be prevented from progressing when well controlled with a regimen of exercise, diet, and medication.
•    Osteoarthritis is an inflammatory disease of the joints that may present symptoms at any age.
•    Joint degeneration with pain and disability occurs in the majority of people by the age of 60.
Osteoarthritis occurs with greater frequency with increasing age, but it usually remains confined to a few joints and can be managed with a combination of exercise, diet, and medication.

37. When reinforcing health teaching about the management of osteoarthritis, the nurse determines that Piya Jordan, a 68-year-old client, needs additional instruction after making which of the following statements?
•    "I should take the celecoxib (Celebrex) as prescribed to help control the pain."
•    "I should try to stay active throughout the day to keep my joints from becoming stiff." Correct
•    "A warm shower in the morning will help relieve the stiffness I have when I get up."
•    "I can use a cane if I find it helpful in relieving the pressure on my back and hip."
It is important to maintain a balance between rest and activity to avoid overstressing the joints with osteoarthritis.

38. Piya Jordan, a 68-year-old client with osteoarthritis of the knees, has been taking celecoxib (Celebrex) 200 mg every 12 hours. The client states that the drug does not seem to work as well as it used to in controlling the pain. The nurse's response to the client is based on the knowledge that:
•    The client is probably not compliant with the drug therapy.
•    If NSAIDs are not effective in controlling her symptoms, systemic corticosteroids are the next line of therapy.
•    Another nonsteroidal antiinflammatory drug (NSAID) may be indicated because of individual variations in response to drug therapy. Correct
•    It may take several months for NSAIDs to reach therapeutic levels in the blood.
Clients vary in their responses to medications, and another type of NSAID may be tried. This NSAID is a cyclooxygenase-2 (COX-2) inhibitor, which decreases the risk of GI bleeding.

39. A colectomy is scheduled for Piya Jordan, a 68-year-old woman with an abdominal mass, suspected bowel obstruction, and a history of rectal polyps. The nurse should plan to include which of the following prescribed measures in the preoperative preparation of this client?
•    A high-fiber diet on the day before surgery
•    Administration of IV antibiotics for bowel preparation
•    Instruction on irrigating a colostomy
•    Administration of a cleansing enema Correct
Preoperative preparation for bowel surgery typically includes bowel cleansing with antibiotics such as oral neomycin and cleansing enemas, including Fleet enemas.

40. During a preoperative assessment, the nurse places the high priority on determining the client's current medications for which of the following primary reasons?
•    These medications may alter the patient's perceptions about surgery.
•    Anesthetics alter renal and hepatic function, causing toxicity by other drugs.
•    Other medications may interact with anesthetics, altering the potency and effect of the drugs. Correct
•    Routine medications are usually withheld the day of surgery, requiring dosage and schedule adjustments.
Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that it has been communicated to the anesthesiologist.

41. The highest-priority information to include in preoperative teaching for Piya Jordan, a 68-year-old client scheduled for a colectomy, would be which of the following?
•    How to deep-breathe and cough Correct
•    How to care for the wound
•    What medications will be used during surgery
•    The location and care of drains after surgery
Because anesthesia, an abdominal incision, and pain can impair the client's respiratory status in the postoperative period, it is of high priority to teach the client to cough and deep-breathe. Otherwise, atelectasis and pneumonia, could develop, delaying recovery from surgery and, as a result, hospital discharge.

42. The nurse asks Piya Jordan, a 68-year-old client scheduled for colectomy, to sign the operative permit as directed in the physician's preoperative orders. The client states that the physician has not really explained what is involved in the surgical procedure. Which of the following is the most appropriate action by the nurse?
•    Ask family members whether they have discussed the surgical procedure with the physician.
•    Explain what the planned surgical procedure as well as possible and have the client sign the consent form.
•    Delay the patient's signature on the consent and notify the physician about the conversation with the client. Correct
•    Have the client sign the form and state that the physician will visit to explain the procedure before surgery.
The client should not be asked to sign a consent form unless the procedure has been explained to her satisfaction. The nurse should notify the physician, who has the responsibility for obtaining consent.

43. Piya Jordan, a 68-year-old client, refuses to remove her wedding ring on the morning of surgery. The nurse should take which of the following actions?
•    Explain that the hospital will not be responsible for the ring or her finger.
•    Note the presence of the ring in the nurses' notes section of the chart.
•    Tape the ring securely to the finger. Correct
•    Insist that the client remove the ring and take it to the hospital safe.
It is customary to tape a client's wedding band to the finger and make a notation on the preoperative checklist that the ring has been taped in place.

44. Piya Jordan, a 68-year-old client with an abdominal mass, is scheduled for surgery today. Before she is admitted to the operating room, which preoperative documentation item must be attached to the chart?
•    Physical-examination findings Correct
•    A functional-status evaluation
•    An electrocardiogram
•    Laboratory-test findings, including kidney- and liver-function parameters
It is essential that a physical examination report be attached to the chart of a client going into surgery. This document explains in detail the overall status of the client for the surgeon and other members of the surgical team.

45. When Piya Jordan is transferred from the PACU to the clinical surgical unit after colectomy, the first action by the nurse on the surgical unit should be to do which of the following?
•    Check the physician's postoperative orders.
•    Check the rate of the IV infusion.
•    Take the client's vital signs. Correct
•    Assess the client's pain.
The highest-priority action by the nurse is to assess the physiological stability of the client. This is in part accomplished by taking the client's vital signs. The other actions can then take place in rapid sequence.

46. While caring for Piya Jordan after colectomy, on the first postoperative day, the nurse notes new bright-red drainage about 5 cm in diameter on the surgical dressing. In response to this finding, the nurse should do which of the following next?
•    Take the client's vital signs. Correct
•    Remove the dressing and assess the surgical incision.
•    Notify the surgeon of a potential hemorrhage.
•    Recheck the dressing in 1 hour for increased drainage.
The first action by the nurse is to gather additional assessment data to form a more complete clinical picture. The nurse can then report the findings as a whole.

47. In planning postoperative interventions to promote ambulation, coughing, deep breathing, and turning for Piya Jordan after colectomy, the nurse recognizes that the desired outcomes are more likely if Piya Jordan:
•    Receives positive feedback when the activities are completed.
•    Is warned about possible complications if the activities are not performed.
•    Can easily explain the rationale for these activities.
•    Receives enough analgesics to promote relative freedom from pain. Correct
Even when a client understands the importance of postoperative activities, it is unlikely that the best outcome will occur unless the client has sufficient pain relief to cooperate.

48. Two days after colectomy for an abdominal mass, Piya Jordan reports gas pains and abdominal distension. The nurse plans care for the client on the basis of the knowledge that these symptoms occur as a result of which of the following?
•    Inflammation of the bowel at the anastomosis site
•    Nasogastric suctioning
•    Impaired peristalsis Correct
•    Irritation of the bowel
Until peristalsis returns to normal after anesthesia, the client may experience slowed gastric motility, leading to gas pains and abdominal distension.

49. After bowel resection, Piya Jordan has a nasogastric tube for suction but complains of nausea and stomach distension. The nurse irrigates the tube PRN as ordered, but the irrigating fluid does not return. Which of the following should be the priority action by the nurse?
•    Remove the tube and replace it with a new one.
•    Auscultate for bowel sounds.
•    Notify the physician.
•    Reposition the tube and check for placement. Correct
The tube may be resting against the stomach wall. The first action by the nurse, because this is intestinal surgery (not gastric surgery), is to reposition the tube and check it again for placement.

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