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 B

Explanation

B. Changing the IV tubing every 24 hours helps prevent the accumulation of bacteria and other contaminants within the tubing, reducing the risk of infection. This practice is particularly important for clients receiving TPN, as they are at higher risk of infection due to the direct infusion of nutrients into the bloodstream.
A. It is essential to maintain the integrity of the IV site to prevent infection and ensure proper TPN delivery. Changing the IV site dressing every 24 hours helps minimize the risk of contamination and infection at the insertion site.
C. Regular monitoring of the client's weight is not necessary.
D. While monitoring blood glucose levels is important for clients at risk of hyperglycemia or hypoglycemia, the frequency of monitoring should be individualized based on the client's clinical condition and risk factors.

A. cleans and dries the perianal area after each diarrheal stool. B. uses alcohol compresses to provide relief from anal irritation. C. asks for antidiarrheal medication after each stool. D. takes an hour-long Sitz bath following each stool.

Correct Answer is A

Explanation

A. Cleans and dries the perianal area after each diarrheal stool: This is the correct option. Effective perianal care for a client with diarrhea, such as ulcerative colitis, involves gentle cleansing and thorough drying of the perianal area after each stool. Proper hygiene helps prevent skin breakdown and irritation caused by prolonged contact with stool.
B. Alcohol can be irritating to the skin and may exacerbate perianal irritation and discomfort. Therefore, using alcohol compresses is not considered an appropriate perianal care practice.
C. While antidiarrheal medications may be prescribed for clients with ulcerative colitis to help manage symptoms, asking for medication after each stool is not a typical or recommended approach. The frequency and timing of antidiarrheal medication administration should be based on healthcare provider recommendations and individual symptom management plans.
D. While Sitz baths can provide relief from perianal discomfort and promote healing, taking an hour-long Sitz bath after each stool may be impractical and excessive. Sitz baths are typically recommended for shorter durations (e.g., 10-20 minutes) and may be used periodically rather than after every stool.

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Naxlex Comprehensive Predictor Exams

The nurse is assessing a client who is receiving total parenteral nutrition (TPN) therapy via an Infusion pump. Which action would be appropriate?

Correct Answer is B

Explanation

The nurse identifies a client problem of impaired skin integrity related to diarrhea for a client who has ulcerative colitis. The nurse recognizes that teaching about perianal care has been effective when the client:

Correct Answer is A

Explanation

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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?

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