Client Has Continuous Nasogastric Suction with Large Amounts of Gastric Drainage. Which Acid-Base Imbalance Is the Client at Greatest Risk of Developing? a

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Sample questions from Client Has Continuous Nasogastric Suction with Large Amounts of Gastric Drainage. Which Acid-Base Imbalance Is the Client at Greatest Risk of Developing? a

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In a pediatric medical unit, a 9-year-old with a bowel obstruction has continuous nasogastric suction that has collected 1,100 mL of green drainage over 8 hours. The child is restless and reports leg cramps; potassium is 2.9 mEq/L and chloride is 88 mEq/L. Which action should the nurse take first?

   • A.Notify the provider of the drainage volume, symptoms, and electrolyte results
   • B.Document the findings and reassess the child in 4 hours
   • C.Increase the suction pressure to remove the remaining gastric contents
   • D.Offer the child oral potassium-rich fluids

   Rationale: Large gastric losses can cause chloride-depletion metabolic alkalosis and hypokalemia, and the cramps and abnormal results require prompt evaluation and treatment. Increasing suction could worsen the losses, while oral fluids are inappropriate for a client with an obstruction and prescribed decompression. Waiting to reassess delays care for clinically significant electrolyte abnormalities.

2. 2.At change of shift in a surgical unit, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 55-year-old with a dry dressing and a temperature of 37.8 C 8 hours after surgery
   • B.A 42-year-old 1 day after appendectomy who rates incisional pain 7/10 and has a heart rate of 96/min
   • C.A 68-year-old with continuous nasogastric suction who is newly confused, with respirations of 10/min and a potassium level of 2.7 mEq/L
   • D.A 73-year-old awaiting discharge instructions whose nasogastric tube was removed this morning

   Rationale: New confusion, hypoventilation, and severe hypokalemia in a client losing gastric contents suggest a potentially worsening metabolic alkalosis with risk of dysrhythmia and respiratory compromise. The pain requires assessment and treatment, but the other client is currently showing more urgent signs of physiologic instability. A low-grade temperature and routine discharge teaching can be addressed after the unstable client is assessed.

3. 3.In a medical unit, a 34-year-old with continuous nasogastric suction has produced 900 mL of drainage in 6 hours. The client reports weakness and palpitations; potassium is 2.8 mEq/L, chloride is 89 mEq/L, and the cardiac monitor shows frequent premature ventricular complexes. Which actions should the nurse take? Select all that apply.

   • A.Administer prescribed potassium replacement using the required infusion safeguards
   • B.Clamp the nasogastric tube without an order to stop further electrolyte losses
   • C.Assess the cardiac rhythm and promptly notify the provider of the findings
   • D.Review the prescribed fluid replacement plan and report the ongoing drainage amount
   • E.Give potassium by IV push for the most rapid correction

   Rationale: Frequent ventricular ectopy with potassium of 2.8 mEq/L warrants prompt rhythm assessment and provider notification, and prescribed potassium replacement should be administered with infusion safeguards. The high drainage volume should be communicated while the nurse reviews the ordered replacement plan because gastric losses can worsen chloride depletion and alkalosis. Clamping the tube without an order may compromise decompression, and IV-push potassium is unsafe.

4. 4.During a home visit, a 76-year-old with a recently placed nasogastric tube for bowel obstruction says, 'I feel dizzy when I stand.' The caregiver reports 1,400 mL of drainage in the past day; the client takes digoxin and has a blood pressure of 96/58 mm Hg. Which instruction should the nurse give the caregiver first?

   • A.Pause the suction and restart it at half pressure after the dizziness passes
   • B.Give an extra dose of digoxin to address possible weakness
   • C.Encourage the client to stand and walk frequently to prevent deconditioning
   • D.Keep the client seated or lying down and contact the treating clinician promptly about the drainage and dizziness

   Answer and rationale are in the full material.

5. 5.A provider prescribes potassium chloride for a 51-year-old receiving continuous nasogastric suction. The client has a potassium level of 3.0 mEq/L, urine output of 15 mL/hr for the past 2 hours, and an estimated glomerular filtration rate of 24 mL/min/1.73 m2. What should the nurse do?

   • A.Ask an assistive personnel to administer the potassium while the nurse reassesses urine output
   • B.Hold the potassium dose and clarify the prescription with the provider
   • C.Give the potassium with an oral fluid bolus to improve renal excretion
   • D.Administer the prescribed potassium immediately because gastric suction causes potassium loss

   Answer and rationale are in the full material.