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. Increase fiber in the diet: This is the correct option. Increasing dietary fiber intake is one of the most important interventions to prevent diverticular disease and reduce the risk of diverticulitis. Adequate fiber intake promotes regular bowel movements and prevents constipation, which can help reduce pressure in the colon and minimize the formation of diverticula.
A. Nuts and seeds are excellent sources of dietary fiber, which may actually help prevent diverticular disease. Therefore, while avoiding nuts and seeds may be advised during an acute diverticulitis flare-up to reduce irritation to the colon, it is not the most important long-term preventive intervention.
C. While stress management techniques may contribute to overall health and well-being, they are not the most important intervention specifically for preventing diverticular disease.
D. While physical activity and exercise are important for overall health and may help improve bowel function, there is limited evidence to suggest that strengthening abdominal muscles alone can prevent diverticular disease.

A. Urine specific gravity and antigen levels B. Urine characteristics and output C. Appearance of the surgical site D. Results of clean catch urine specimens

Correct Answer is B

Explanation

B. After ESWL for a urinary stone, it is essential to monitor the client's urine characteristics (such as color, clarity, and presence of blood) and output. The presence of hematuria is a common and expected finding after ESWL due to the disruption of tissue and blood vessels during the procedure. Monitoring urine output helps assess renal function and ensures adequate hydration, which is crucial for flushing out stone fragments.
A. While monitoring urine specific gravity can provide information about the concentration of urine, and assessing antigen levels may be relevant in certain contexts, these parameters are not typically the most important information to collect immediately after extracorporeal shock-wave lithotripsy (ESWL) for a urinary stone.
C. While it is important to monitor the surgical site for signs of infection or complications after any procedure, ESWL is a non-invasive procedure performed externally, typically without any incisions.
D. While obtaining clean catch urine specimens for urinalysis and culture may be relevant for assessing urinary tract infection or other urinary abnormalities, it is not typically the most important information to collect immediately after ESWL.

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Naxlex Comprehensive Predictor Exams

The client is being discharged after being seen in the urgent care center for a possible first experience with diverticulitis. The client asks the nurse what can be done to prevent further development of diverticular disease. The nurse's most important intervention to teach this client would be to:

Correct Answer is B

Explanation

A client who has a confirmed urinary stone in the proximal left ureter undergoes extracorporeal shock- wave lithotripsy. What Information is most Important for the nurse to collect after lithotripsy?

Correct Answer is B

Explanation

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