C HAPTER 15: E LIMINATION AND G ASTRIC
I NTUBATION
Cooper: Foundation of Nu rsing, 9th Edition
MULTIPLE CHOICE
1. During insertion of a Foley catheter, the patient grimaces as the balloon is
inflated. What is the immediate reaction of the nurse?
a. Withdraw the catheter.
b. Ask the patient to bear down.
c. Continue to inflate the balloon.
d. Advance the catheter into the bladder.
ANS: D
Grimacing is a sign of pain indicating that the balloon might be in the
urethra instead of the bladder. The catheter should be advanced before
inflation.
DIF: Cognitive Level: Application REF: p. 360 OBJ: 1
TOP: Catheterization KEY: Nursing Process Step:
Assessment MSC: NC LEX: Physiological Integrit y
2. When explaining the difference between a colostom y and an ileostom y,
the nurse explains which of the following about an ileostom y?
a. It is always permanent.
b. It drains semiliquid stool.
, c. It has a much larger stoma.
d. It does not need a pouch.
ANS: B
The ileostom y is higher in the GI tract and drains semiliquid stool. The
ileostom y is very similar in appearance to the colostom y, may not be
permanent, and needs a pouch.
DIF: Cognitive Level: Comprehension REF: p. 383
OBJ: 7 TOP: Ileostom y KEY: Nursing Process
Step: Implementation MSC: NC LEX: Physiological
Integrit y
3. Before inserting a nasogastric tube, what measurement should the nurse
take?
a. Tip of the nose to the earlobe to the xiphoid process
b. Bridge of the nose to the xiphoid process
c. Nose to the top of the ear to the stomach
d. Clavicular notch to the stomac h
ANS: A
The measurement is from the tip of the nose to the ear lobe to the
xiphoid process.
DIF: Cognitive Level: Application REF: p. 376 OBJ: 3
TOP: Nasogastric (NG) tube KEY: Nursing Process
I NTUBATION
Cooper: Foundation of Nu rsing, 9th Edition
MULTIPLE CHOICE
1. During insertion of a Foley catheter, the patient grimaces as the balloon is
inflated. What is the immediate reaction of the nurse?
a. Withdraw the catheter.
b. Ask the patient to bear down.
c. Continue to inflate the balloon.
d. Advance the catheter into the bladder.
ANS: D
Grimacing is a sign of pain indicating that the balloon might be in the
urethra instead of the bladder. The catheter should be advanced before
inflation.
DIF: Cognitive Level: Application REF: p. 360 OBJ: 1
TOP: Catheterization KEY: Nursing Process Step:
Assessment MSC: NC LEX: Physiological Integrit y
2. When explaining the difference between a colostom y and an ileostom y,
the nurse explains which of the following about an ileostom y?
a. It is always permanent.
b. It drains semiliquid stool.
, c. It has a much larger stoma.
d. It does not need a pouch.
ANS: B
The ileostom y is higher in the GI tract and drains semiliquid stool. The
ileostom y is very similar in appearance to the colostom y, may not be
permanent, and needs a pouch.
DIF: Cognitive Level: Comprehension REF: p. 383
OBJ: 7 TOP: Ileostom y KEY: Nursing Process
Step: Implementation MSC: NC LEX: Physiological
Integrit y
3. Before inserting a nasogastric tube, what measurement should the nurse
take?
a. Tip of the nose to the earlobe to the xiphoid process
b. Bridge of the nose to the xiphoid process
c. Nose to the top of the ear to the stomach
d. Clavicular notch to the stomac h
ANS: A
The measurement is from the tip of the nose to the ear lobe to the
xiphoid process.
DIF: Cognitive Level: Application REF: p. 376 OBJ: 3
TOP: Nasogastric (NG) tube KEY: Nursing Process
