A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During pre-operative teaching, the nurse is reinforcing information about the procedure. Which of the following explanations is most accurate?

Correct Answer: B

Rationale: The correct answer is B) The procedure will result in anastomosis of the gastric stump to the jejunum. This explanation is accurate because a Billroth II procedure involves the surgical removal of part of the stomach (subtotal gastrectomy) and the attachment of the remaining stomach to the jejunum (anastomosis). This allows for the stomach to continue to empty its contents into the small intestine for digestion. Option A is incorrect because a subtotal gastrectomy does not involve enlargement of the pyloric sphincter. Option C is incorrect as the duodenum is not removed during a Billroth II procedure. Option D is incorrect as the vagus nerve is not repositioned during this surgery. In an educational context, understanding the specifics of surgical procedures like the Billroth II procedure is crucial for nurses caring for patients undergoing such surgeries. Providing accurate pre-operative teaching empowers patients to participate in their care and recovery effectively. It also ensures that they have realistic expectations and are prepared for the post-operative period.

Correct Answer: C

Rationale: In the context of caring for a client after a subtotal gastrectomy, option C - "Monitor the client for N/V, and abdominal distention" is the correct nursing intervention for the care of the nasogastric tube and drainage system. Rationale for option C: After a subtotal gastrectomy, the client is at risk for postoperative complications such as nausea, vomiting (N/V), and abdominal distention due to alterations in their gastrointestinal anatomy and function. Monitoring for these signs and symptoms is crucial as they can indicate issues with gastric emptying, bowel obstruction, or other complications that may require prompt intervention. Explanation for why the other options are incorrect: A) Option A suggesting to irrigate the tube with sterile water every hour is unnecessary and can disrupt the natural drainage process, potentially leading to complications such as electrolyte imbalances or tube displacement. B) Repositioning the tube if it is not draining well (Option B) may not address the underlying cause of poor drainage and could cause discomfort or injury to the client if done without proper assessment. D) Option D advising to turn the machine to high suction if drainage is sluggish on low suction is not appropriate as high suction can cause trauma to the gastric mucosa and increase the risk of complications. Educational context: Understanding the rationale behind each nursing intervention is essential for providing safe and effective care to postoperative clients, especially those undergoing gastrointestinal surgeries. By prioritizing monitoring for common post-gastrectomy complications like N/V and abdominal distention, nurses can promptly identify and address any issues, ensuring optimal recovery and outcomes for the client.

Correct Answer: D

Rationale: In the scenario of a client who has undergone a subtotal gastrectomy for cancer, the expected nutritional outcome would be to achieve optimal nutritional status through oral or parenteral feedings, which is option D. This is because a subtotal gastrectomy involves the removal of a significant portion of the stomach, impacting the client's ability to adequately digest and absorb nutrients from food. As a result, they may require supplemental nutrition through oral or parenteral routes to meet their nutritional needs and prevent malnutrition. Option A, regaining weight loss within 1 month after surgery, is not the most appropriate outcome to focus on immediately post subtotal gastrectomy as the client's ability to consume and absorb nutrients will be compromised. Option B, resuming normal dietary intake of three meals per day, may not be feasible due to the reduced stomach capacity and altered digestion post-surgery. Option C, controlling nausea and vomiting through regular use of antiemetics, addresses symptoms but does not directly address the client's nutritional needs. In an educational context, understanding the nutritional implications of gastrointestinal surgeries like subtotal gastrectomy is crucial for nursing students. It highlights the importance of individualized nutritional care plans and the use of alternative feeding methods to ensure clients receive adequate nutrition despite anatomical changes. This knowledge helps students provide holistic care and support to clients undergoing such procedures.

Correct Answer: D

Rationale: In a client with GERD (Gastroesophageal Reflux Disease) experiencing a chronic cough, the indicative condition would be option D: Aspiration of gastric contents. This occurs when stomach contents reflux back into the esophagus and then are aspirated into the respiratory tract, leading to respiratory symptoms like coughing. Option A, development of laryngeal cancer, is incorrect as chronic cough in GERD is not directly linked to cancer but rather to the reflux of gastric contents. Option B, irritation of the esophagus, while a common consequence of GERD, does not directly cause a chronic cough. Option C, esophageal scar tissue formation, is also a possible complication of GERD but is not the primary reason for a chronic cough in this scenario. Educationally, understanding these relationships is crucial for nurses caring for patients with GERD. Recognizing the manifestations of GERD and its potential complications, like aspiration of gastric contents leading to respiratory symptoms, enables nurses to provide appropriate interventions and education to manage symptoms effectively and prevent further complications.

Correct Answer: A

Rationale: In the context of preventing esophageal reflux, the correct answer is A) Eating small, frequent meals. This dietary measure helps by reducing the amount of food in the stomach at one time, which can decrease the likelihood of gastric contents refluxing back into the esophagus. By eating smaller, more frequent meals, there is less pressure on the lower esophageal sphincter, the muscle that normally prevents reflux. Option B) Increasing fluid intake is not directly related to preventing esophageal reflux. While staying hydrated is important for overall health, it does not specifically address the issue of reflux. Option C) Avoiding air swallowing with meals is more relevant to preventing gas and bloating rather than esophageal reflux. Option D) Adding a bedtime snack to the dietary plan can actually worsen esophageal reflux. Eating close to bedtime can increase the risk of reflux due to lying down shortly after eating, which can allow stomach acid to flow back into the esophagus. In the educational context of medical-surgical nursing, understanding the impact of dietary measures on gastrointestinal health is crucial. By selecting the appropriate dietary interventions, nurses can help patients manage and prevent conditions like esophageal reflux, promoting better outcomes and quality of life. It is essential to educate patients on the importance of dietary modifications in managing gastrointestinal disorders to enhance their understanding and self-care abilities.