A child with severe gastroesophageal reflux disease (GERD) is scheduled for Nissen fundoplication. Postoperative nursing management should include (select all that apply):
Starting bolus feedings to stretch the stomach
Venting gastrostomy tube
Keeping child flat in bed to increase absorption of food
Observing for abdominal distension, flushing and hypotension which may indicate dumping syndrome
Correct Answer : B,D
Choice A reason: Starting bolus feedings to stretch the stomach is not recommended for a child with Nissen fundoplication as it can cause increased pressure on the surgical site and lead to complications such as bleeding, perforation, or slippage of the wrap.
Choice B reason: Venting gastrostomy tube is a correct answer as it allows for the release of gas and fluids from the stomach and prevents gastric distension and discomfort. A gastrostomy tube is often placed during Nissen fundoplication to facilitate feeding and venting.
Choice C reason: Keeping child flat in bed to increase absorption of food is not advised for a child with Nissen fundoplication as it can increase the risk of aspiration and pneumonia. The child should be positioned at a 30-degree angle or higher after feeding to prevent reflux.
Choice D reason: Observing for abdominal distension, flushing and hypotension which may indicate dumping syndrome is a correct answer as it is a potential complication of Nissen fundoplication. Dumping syndrome occurs when food moves too quickly from the stomach to the small intestine, causing symptoms such as abdominal cramps, nausea, diarrhea, sweating, and dizziness.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Increased stroke volume is not a correct answer as it means that the heart pumps more blood with each contraction. This would result in increased blood pressure and perfusion, not cool extremities, weak pulses, and low urine output.
Choice B reason: Cardiac arrhythmia is not a correct answer as it means that the heart beats irregularly or abnormally. This can cause palpitations, chest pain, or fainting, but not necessarily cool extremities, weak pulses, and low urine output.
Choice C reason: Decreased cardiac output is a correct answer as it means that the heart pumps less blood than the body needs. This can result from a ventricular septal defect, which causes blood to shunt from the left ventricle to the right ventricle, reducing the amount of oxygenated blood that reaches the tissues. This can cause cool extremities, weak pulses, and low urine output, as well as fatigue, poor growth, and shortness of breath.
Choice D reason: Cyanosis is not a correct answer as it means that the skin, lips, or nails turn blue due to low oxygen levels in the blood. This can occur in some cases of ventricular septal defect, especially if there is pulmonary hypertension or a reversal of the shunt. However, cyanosis is not a direct cause of cool extremities, weak pulses, and low urine output.
Correct Answer is D
Explanation
Choice A reason: Somnolence, hypotension, and oliguria are signs of decompensated shock, which occurs when the body's compensatory mechanisms fail to maintain adequate tissue perfusion.
Choice B reason: Irritability, tachypnea, and hypotension are also signs of decompensated shock, as the respiratory rate increases to compensate for the low blood pressure and oxygen delivery.
Choice C reason: Irritability, capillary refill time > 2 seconds, and bradycardia are not typical signs of compensated shock, as the heart rate usually increases to maintain cardiac output and blood pressure.
Choice D reason: Irritability, tachycardia, and poor peripheral perfusion are signs of compensated shock, which occurs when the body tries to maintain adequate tissue perfusion by increasing the heart rate, constricting the peripheral blood vessels, and shunting blood to the vital organs.
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