This is a quiz that contains NCLEX review questions about t-tube nursing care. As a nurse providing care to a patient with a t-tube, it is important to know how to manage this device.
In the previous NCLEX review series, I explained about other GI disorders you may be asked about on the NCLEX exam, so be sure to check out those reviews and quizzes as well.
Don’t forget to watch the lecture on t-tube care being taking the quiz.
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T-Tube NCLEX Questions for Nursing Care
1. A patient had a cholecystectomy and has a t-tube in place. You’re helping the nursing student understand how to care for the t-tube. The nursing student asks you where the t-tube is located in the body. Your response is the:
A. Cystic duct
B. Hepatic duct
C. Bile duct
D. Pancreatic duct
The answer is C. The t-tube is located in the bile duct. It will serve as a drain to help remove bile from the liver until the common bile duct is healed.
2. The nurse helps the patient with a t-tube get up from the bed and sit in the bedside chair. Where will the nurse make it priority to position the tubing and drainage bag of the t-tube?
A. Slightly elevated above the t-tube insertion site
B. At heart level
C. Midline with the t-tube insertion site
D. At or below the waist
The answer is D. The t-tube drainage bag and tubing will work with the assistance of gravity to drain the bile. Therefore, the tubing and drainage bag should be below the t-tube insertion site (which is at or below the waist) to help drain bile.
3. Which position is best for a patient with a t-tube?
C. Right lateral recumbent
D. Left lateral recumbent
The answer is B. To help facilitate drainage (remember in order for the t-tube to work it needs the assistance of gravity), positioning the patient at about 30-45 degrees (the Semi-Fowler’s position) will be the best.
4. A patient is post-op day 4 from a t-tube placement. Which finding below requires you to notify the physician?
A. Drainage from the t-tube is yellowish green.
B. Drainage from the t-tube within the past 24 hours is approximately 925 cc.
C. Blood tinged drainage from the t-tube has decreased.
D. Patient reports a decrease in nausea.
The answer is B. A drainage amount of 500 cc or more within a 24 hour period is abnormal and the physician should be notified. On post-op day 4 the drainage should be decreasing (NOT increasing). It is normal for the drainage to be yellowish green. Also blood tinged drainage will decrease in the t-tube at this time (fresh post-op like day 1-2 it may be blood tinged but this will decrease over time). The patient reporting a decrease in nausea is a positive sign.
5. The physician orders a patient’s t-tube to be clamped 1 hour before and 1 hour after meals. You clamp the t-tube as prescribed. While the tube is clamped which finding requires immediate nursing intervention?
A. The t-tube is not draining.
B. The t-tube tubing is below the patient’s waist.
C. The patient reports nausea and abdominal pain.
D. The patient’s stool is brown and formed.
The answer is C. A nurse should ONLY clamp a t-tube with a physician’s order. Most physicians will prescribe to clamp the t-tube 1 hour before and 1 hour after meals. WHY? So, bile will flow down into the small intestine (instead out of the body) during times when food is in the small intestine to help with the digestion of fats. This is to help the small intestine adjust to the flow of bile in preparation for the removal of the t-tube (remember normally it received bile when the gallbladder contracted but now it will flow from the liver to the small intestine continuously). Option C is an abnormal finding. The patient should not report nausea or abdominal pain when the tube is blocked. This could indicate a serious problem. Option A is correct because the t-tube should not be draining because it’s clamped. Option B is correct because the t-tube tubing should be below or at the patient’s waist level. Option D is correct because this shows the body is digesting fats and bilirubin is exiting the body through the stool (remember bilirubin is found in the bile and gives stool its brown color…it would be light colored if the bilirubin was not present). You would NOT want to see steatorrhea (fat/greasy liquid stools) because this shows the bile isn’t being delivered to help digest the fats.
6. You’re assessing a patient’s t-tube and note that it is not draining bile. The patient is reporting nausea. The nurse will first?
A. Notify the physician
B. Assess if the tubing from the t-tube is kinked or clamped.
C. Flush the tubing.
D. Administer an antiemetic medication per physician order.
The answer is B. First, the nurse should make sure the tubing is not kinked or clamped. This is a quick action the nurse can perform before proceeding. The nurse should ONLY flush the tubing if he or she has a physician’s order to do so. If the nurse can’t determine the problem, the physician should then be notified.
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