A 30-year old client experiences weight loss, abdominal distention, crampy abdominal pain, and intermittent diarrhea after the birth of her 2nd child. Diagnostic tests reveal gluten-induced enteropathy. Which foods must she eliminate from her diet permanently?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Cereal grains (except rice and corn) that the client must eliminate from her diet permanently due to gluten-induced enteropathy, also known as celiac disease. Gluten is a protein found in wheat, barley, and rye, which are cereal grains. When individuals with celiac disease consume gluten, it triggers an immune response that damages the lining of the small intestine, leading to malabsorption of nutrients and various gastrointestinal symptoms. Option A) Milk and dairy products do not need to be eliminated unless the individual also has lactose intolerance or a separate dairy-related condition. Option B) Protein-containing foods are essential for overall health and should not be eliminated unless there is a specific allergy or intolerance. Option D) Carbohydrates are a broad category of nutrients and eliminating all carbohydrates is not necessary or healthy. From an educational perspective, this question highlights the importance of recognizing dietary restrictions in individuals with specific health conditions such as celiac disease. Understanding the role of gluten in triggering symptoms and the need for strict adherence to a gluten-free diet is crucial in managing this condition effectively and preventing complications. It also emphasizes the significance of nutritional therapy in the treatment of gastrointestinal disorders and the impact of diet on overall health outcomes.

Correct Answer: D

Rationale: In medical surgical nursing, it is crucial to understand the rationale behind positioning a client with a percutaneous endoscopic gastrostomy (PEG) tube for tube feedings. The correct answer is D) High Fowler's position. Placing the client in High Fowler's position (sitting up at a 90-degree angle) helps prevent aspiration during feeding by promoting optimal digestion and reducing the risk of reflux. This position also facilitates the movement of food through the gastrointestinal tract and minimizes the risk of regurgitation. Option A) Semi-Fowler's position is not the ideal choice as it does not provide as much elevation as High Fowler's, which is necessary to reduce the risk of aspiration. Option B) Supine position is contraindicated for PEG tube feedings as it increases the risk of regurgitation and aspiration. Option C) Reverse Trendelenburg, with the head of the bed elevated and the foot of the bed lowered, is not as effective as High Fowler's in preventing aspiration and promoting optimal digestion. In an educational context, understanding the importance of positioning in tube feedings is vital for nurses caring for clients with PEG tubes. By knowing the rationale behind positioning choices, nurses can provide safe and effective care, prevent complications such as aspiration pneumonia, and promote optimal outcomes for their patients undergoing enteral feedings.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Question the physician about the order. The rationale behind this is that administering an enema to a client suspected of having appendicitis can be dangerous as it may lead to rupture of the inflamed appendix. Therefore, it is crucial for the nurse to question the order and seek clarification from the physician before proceeding with the procedure. Option A) Prepare 750 ml of irrigating solution warmed to 100*F is incorrect because administering an enema in this situation can exacerbate the client's condition. Option C) Provide privacy and explain the procedure to the client is incorrect as it does not address the potential harm that an enema can cause in a client with suspected appendicitis. Option D) Assist the client to left lateral Sim's position is also incorrect as it focuses on the procedural aspect without considering the implications of the enema on a client with a suspected inflamed appendix. In an educational context, this question highlights the importance of critical thinking and advocating for the safety of the client. Nurses need to be vigilant in assessing the appropriateness of orders, especially in situations where the intervention could potentially harm the client. This rationale emphasizes the significance of understanding the pathophysiology of conditions like appendicitis and applying that knowledge in clinical decision-making to ensure the best outcomes for clients.

Correct Answer: A

Rationale: The correct answer is A) Fast for 8 hours before the test. This instruction is essential before a barium swallow to ensure optimal test results. Fasting helps to empty the stomach and intestines, allowing for better visualization of the gastrointestinal tract during the procedure. Consuming food could interfere with the test by mixing with the barium solution and affecting the imaging quality. Option B) Eat a regular supper and breakfast is incorrect because eating before the test would not provide clear imaging results due to the presence of food particles in the gastrointestinal tract. Option C) Continuing to take all oral medications as scheduled may not be advisable before a barium swallow as certain medications can interfere with the test results or the absorption of barium. Option D) Monitoring bowel movement patterns for constipation is unrelated to the preparation for a barium swallow and does not impact the test procedure. In a medical-surgical nursing context, understanding the importance of proper patient preparation for diagnostic tests is crucial for accurate results and patient safety. Educating patients on the rationale behind pre-test instructions helps them comply with the necessary guidelines for optimal healthcare outcomes.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Sweating and pallor, which indicates the early signs of dumping syndrome. Dumping syndrome occurs when food moves too quickly from the stomach to the small intestine, leading to a rapid influx of fluid into the intestine. This can result in symptoms such as sweating and pallor due to the body's response to the sudden shift in fluid levels. Option A) Abdominal cramping and pain are more commonly associated with conditions like gastroenteritis or bowel obstruction rather than dumping syndrome. Option B) Bradycardia and indigestion are not typical symptoms of dumping syndrome. Instead, tachycardia is more commonly seen due to the body's attempt to compensate for the rapid fluid shift. Option D) Double vision and chest pain are not specific to dumping syndrome but may be indicative of other conditions like a neurological issue or cardiac problem. In an educational context, understanding the signs and symptoms of dumping syndrome is crucial for nurses caring for patients who have undergone gastric surgeries, such as gastric bypass. Recognizing these early signs can prompt timely interventions to alleviate symptoms and prevent complications. It is essential for nurses to be able to differentiate between various gastrointestinal disturbances to provide appropriate care and support to their patients effectively.