Free CBGNA RN Practice Test
1. Prior to a nasogastric tube feeding, a pH check of aspirant reveals a pH of 8. This most likely indicates that the tube tip is in the
b. respiratory system.
c. small intestine.
2. Which of the following is a typical symptom associated with rectoceles?
a. Chronic constipation
b. Chronic diarrhea
c. Pulling sensation in pelvic area
d. Vaginal discharge
3. Which of the following histamine receptor antagonists should those taking oral contraceptive agents or estrogen avoid?
a. Ranitidine (brand name Zantac)
b. Famotidine (brand name Pepcid)
c. Cimetidine (brand name Tagamet)
d. Nizatidine (brand name Axid)
4. A patient is scheduled for anal sphincter electromyography. Which of the patient's medications should be stopped prior to the EMG?
a. Stool softener
5. A patient with a loop ileostomy and a retained distal segment of bowel has copious anal discharge of mucous. Which of the following is the most likely cause?
a. Normal mucous production
b. Diversion colitis
c. Anastomotic leak
d. Fluid and electrolyte imbalance
Answers & Explanations
1. B: A pH greater than 7 (alkaline) of aspirant from an NG tube most likely indicates that the tube tip is in the respiratory system. Gastric fluids tend to be acidic (although this can be altered by medications), so pH usually ranges from 1 to 4. The pH in intestinal fluids is less acidic and should be approximately 6 or higher. Some tubes have pH sensors in place and do not require aspiration to check. Checking pH is not effective with continuous feedings because tube feedings usually have a pH of 6.6 and a neutralizing effect on gastrointestinal pH.
2. A: Rectoceles can cause chronic constipation and difficulty in passing stool because of weakening of the muscles, contributing to fecal incontinence. Untreated, rectoceles can cause inflammation, ulcerations, and fistula formation. Pessaries may reduce the prolapse. Surgical repair may not correct all symptoms, especially underlying damage to muscles, and can result in surgical trauma to the rectum or sphincters, adding to the risk of incontinence. Rectoceles (rectal prolapses) occur when the muscles between the wall of the vagina and rectum weaken and the rectum prolapses or protrudes.
3. C: Cimetidine (brand name Tagamet): First developed but used less frequently than others because of inhibition of enzymes that results in drug interactions, especially with contraceptive agents and estrogen. Ranitidine (brand name Zantac): Developed to decrease drug interactions and improve patient tolerance. Its activity is about 10 times that of cimetidine. It may be used in combination with other drugs to treat ulcers. Famotidine (brand name Pepcid): May be combined with an antacid to increase the speed of effects, as it has a slow onset. It may be used pre-surgically to reduce postoperative nausea. Nizatidine (brand name Axid): Latest to be developed and about equal in potency and action to ranitidine.
4. B: Anal sphincter electromyography (EMG) assesses muscle contractions to determine if the sphincter muscles are contracting properly. Drugs such as muscle relaxants and cholinergic and anti-cholinergic preparations can affect the outcome of the test. The procedure beings with the patient lying on the left side. A small lubricated sponge or plug electrode is inserted into the anal canal. Alternately, needle electrodes may be used. The patient must lie still during the procedure or results will be affected. Electrical activity of the anal sphincter muscles is recorded on a computer screen while the patient tightens the sphincter muscles, relaxes, and pushes.
5. B: While some anal mucous discharge is normal, copious discharge is often associated with diversion colitis in which the distal segment becomes inflamed. Treatment includes rectal irrigation and topical steroids as well as oral antibiotics. The perianal area should be cleansed. Applying protective cream or ointment prevents irritation of the skin. The mucous fistula should be checked each time the appliance is changed and mucous gently wiped from the opening. The stoma should remain pink. Changes in color or swelling may indicate compromised circulation or infection.
Last Updated: 04/18/2018