An adult client who had bariatric surgery two months ago has developed a postoperative stricture. For the past week, the client has experienced nausea, vomiting, and anorexia, and is admitted to the hospital for fluid resuscitation. At this time the client denies feeling any pain. Which intervention should the nurse implement?
Keep the client NPO.
Administer daily vitamin supplements.
Provide protein-enriched shakes.
Encourage small frequent meals.
The Correct Answer is A
Choice A reason: Keeping the client NPO (nothing by mouth) is essential to prevent further irritation of the gastrointestinal tract and to allow the postoperative stricture to heal. When the client is experiencing significant symptoms like nausea and vomiting, keeping them NPO can help manage these symptoms and prevent complications such as aspiration or worsening of the stricture.
Choice B reason: Administering daily vitamin supplements may be necessary for long-term nutritional management, especially after bariatric surgery. However, in the immediate setting of nausea, vomiting, and a postoperative stricture, this is not the priority intervention.
Choice C reason: Providing protein-enriched shakes may be beneficial for maintaining nutrition in the long term, but it is not appropriate when the client is experiencing nausea, vomiting, and anorexia. Oral intake should be limited until the symptoms subside and the stricture is addressed.
Choice D reason: Encouraging small frequent meals may be beneficial for managing long-term nutritional needs after bariatric surgery, but it is not appropriate during an acute episode of nausea, vomiting, and anorexia. The client should be kept NPO to prevent further complications and allow for proper healing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Frequency of sexual activity can provide useful information about the client's sexual health and habits, but it is not the most critical information needed to address erectile dysfunction. The nurse needs to determine if there are any immediate factors contributing to ED, such as medication side effects.
Choice B reason: Environmental toxin exposure can have long-term health effects, including on sexual function. However, it is not the most urgent factor to consider when evaluating a client with erectile dysfunction. Immediate information about medications and medical history is more pertinent.
Choice C reason: Familial history of diabetes is important because diabetes can affect erectile function due to vascular and neurological complications. Yet, while this background information is useful, it is not the most immediate concern compared to potential medication side effects.
Choice D reason: The current medication regimen is the most important information for the nurse to obtain. Many medications can contribute to erectile dysfunction as a side effect. By identifying the medications the client is taking, the nurse can determine if ED might be a side effect and discuss possible adjustments or alternatives with the healthcare provider.
Correct Answer is A
Explanation
Choice A reason: Occult positive emesis, which indicates the presence of blood in vomit, is a critical finding. It suggests potential gastrointestinal bleeding, which requires immediate medical intervention. This condition can lead to significant blood loss and further complications if not addressed promptly.
Choice B reason: Strong foul-smelling flatus can indicate malabsorption or changes in gut flora, which are common after biliopancreatic diversion. While it can be unpleasant and concerning, it is not as immediately dangerous as gastrointestinal bleeding.
Choice C reason: A report of poor night vision could be related to vitamin A deficiency, which can occur after malabsorptive procedures like BPD. However, it is not an immediate threat compared to the risk of gastrointestinal bleeding.
Choice D reason: Loose bowel movements are common after BPD due to changes in digestion and absorption. While they can contribute to dehydration, they are not as urgent as the presence of blood in vomit.
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