After having a vertical sleeve gastrectomy performed, a 42-year-old male client returns to the surgical nursing unit with a nasogastric tube to low, intermittent suction and a client-controlled analgesia (PCA) machine for pain control. Which nursing action should be included in the post-op plan of care for the first 24 hours?

Teach the client to support the surgical site while deep breathing and coughing

Teach that PCA use may slow the return of bowel function, so the client should not overuse it

Irrigate and reposition the NGT frequently

Offer cups of fruit juices at frequent intervals

Answer and Explanation

The Correct Answer is A

A.   Teach the client to support the surgical site while deep breathing and coughing: This action is appropriate as it helps prevent complications such as atelectasis and pneumonia by promoting lung expansion and clearing secretions. Supporting the surgical site while deep breathing and coughing helps reduce pain and discomfort during these activities.
B.   This is an important teaching point for clients using PCA for pain control after surgery. Opioid medications used in PCA can lead to gastrointestinal motility issues, including constipation. However, pain management is central within the first 24 hours post operation.
C.   Irrigating and repositioning the NGT frequently can increase the risk of complications such as displacement or irritation of the surgical site. NGT care should be performed as needed based on institutional protocols and the client's condition.

D.   The client's diet will likely be advanced gradually, starting with clear fluids and progressing to full liquids and then solid foods as tolerated. Fruit juices may be introduced gradually as part of the liquid diet once the client's gastrointestinal function has recovered sufficiently.

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Correct Answer is ["A","B","D"]

Explanation

A. Eating smaller, more frequent meals can help reduce the likelihood of gastric distention and decrease the pressure on the lower esophageal sphincter (LES), which can help reduce reflux symptoms.
B. Smoking is a risk factor for GERD as it can weaken the LES and increase acid reflux. Therefore, quitting smoking can help alleviate symptoms and improve overall health.
D. Elevating the head of the bed by 6 to 8 inches can help reduce nighttime reflux symptoms by using gravity to prevent stomach acid from flowing back into the esophagus.
C. Proton pump inhibitors (PPIs) like omeprazole are typically taken before meals to inhibit acid production and prevent reflux symptoms. Taking omeprazole after meals may not provide optimal acid suppression when it is most needed.
E. Eating a large meal right before bedtime can increase the likelihood of reflux symptoms as lying down after eating can worsen reflux. It is recommended to avoid large meals, particularly before bedtime, to minimize GERD symptoms.

A. "How are you managing stressful situations?" B. "Have you made an appointment for your annual colonoscopy?" C. "Are you taking your medications regularly?" D. "Are you getting enough rest?"

Correct Answer is C

Explanation

C. Medication adherence is vital for controlling inflammation and preventing flare-ups in ulcerative colitis. Therefore, ensuring that the client is taking their medications as prescribed is a primary focus of disease management, regardless of how well they have learned to manage the condition.
A. Stress can exacerbate symptoms of ulcerative colitis and may contribute to flare-ups. Therefore, understanding how the client manages stress is important. However, given that the client has lived with ulcerative colitis for close to 15 years and has learned to manage it well, this question may be less of a primary focus compared to other aspects of disease management.
B. Regular monitoring through colonoscopy is essential for detecting any changes or complications associated with ulcerative colitis, such as inflammation, dysplasia, or colon cancer.
D. While rest and adequate sleep are important for overall health and well-being, they may not be as directly related to ulcerative colitis management as medication adherence, monitoring, and stress management.

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Naxlex Comprehensive Predictor Exams

The nurse is providing discharge teaching for the client newly diagnosed with GERD. The teaching should Include Instructions to: (SELECT ALL THAT APPLY)

Correct Answer is ["A","B","D"]

Explanation

The client has lived with ulcerative colitis for close to 15 years and has learned to manage it very well. At this point in time, the nurse's discussion with the client about this disease should have a primary focus on which question?

Correct Answer is C

Explanation

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A client with a new diagnosis of GERD is preparing for discharge from the hospital. Which foods will the nurse teach this client to avoid? (SELECT ALL THAT APPLY)

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A nurse is teaching a class about long-term effects of childhood obesity. The nurse should include which of the following conditions as a potential complication of childhood obesity?

What is the most common cause of cystitis?