A client with peptic ulcer is scheduled for a Vagotomy. The client asks the nurse about the purpose of this procedure. The nurse tells the client that the procedure

Correct Answer: D

Rationale: A vagotomy is a surgical procedure performed to treat peptic ulcers by severing branches of the vagus nerve, which provides parasympathetic innervation to the stomach. The vagus nerve stimulates gastric acid secretion through the release of acetylcholine, which activates parietal cells in the stomach lining to produce hydrochloric acid. Excessive acid production is a primary cause of peptic ulcers, as it erodes the mucosal lining, leading to pain, bleeding, or perforation. By interrupting this neural pathway, a vagotomy significantly reduces the acid output, thereby decreasing the acidic environment that perpetuates ulcer formation and allowing the ulcer to heal over time. This directly aligns with option D, which states that the procedure "reduces the stimulus to acid secretions." The stimulus here refers to the vagal nerve signals that trigger acid production, so cutting the nerve effectively dampens this response, providing long-term relief for patients with refractory ulcers not controlled by medications like proton pump inhibitors or H2 blockers. Now, let's examine why the other options are incorrect. Option A, "decreases food absorption in the stomach," is inaccurate because the stomach's primary role is digestion and initial mixing of food with gastric juices, not nutrient absorption—that occurs mainly in the small intestine via villi and microvilli. A vagotomy targets acid regulation and may indirectly affect gastric motility or emptying (depending on the type, like truncal vs. selective vagotomy), but it does not impair absorption mechanisms. In fact, without addressing acid hypersecretion, absorption could be hindered by ongoing inflammation, but the procedure itself isn't designed for that purpose. Option B, "heals the gastric mucosa," oversimplifies the outcome. While reduced acid does promote mucosal healing by minimizing erosion, the vagotomy itself doesn't directly repair or regenerate tissue. Healing is a secondary effect facilitated by the lower acid load, often supported by postoperative medications like antacids or sucralfate. The procedure's core mechanism is preventive—stopping further damage—rather than regenerative, which is why it's not the primary explanation a nurse would give. Option C, "halts stress reactions," is unrelated to the vagotomy's function. Stress can exacerbate ulcers by increasing acid production via the hypothalamic-pituitary-adrenal axis (releasing cortisol and stimulating vagal activity), but the surgery doesn't address psychological or physiological stress responses systemically. It only severs the vagal pathway to the stomach, leaving other stress mediators intact. Managing stress might involve lifestyle changes or therapy, but that's not the goal of this procedure. In summary, understanding the vagus nerve's role in parasympathetic control of gastric function is key: it ramps up acid for digestion, but in peptic ulcer disease, this becomes pathological. A vagotomy restores balance by neural interruption, making D the precise rationale a nurse should convey to educate the client on expected benefits and risks, such as potential dumping syndrome or need for supplemental vitamins if motility is affected. This targeted approach has largely been replaced by less invasive options today, but historically and in select cases, it remains effective for acid control.

Correct Answer: C

Rationale: The correct answer is C, 'Barium swallow.' A barium swallow should be done after a barium enema or gallbladder series to prevent the contrast used in the barium swallow from obstructing the view of other organs. It takes several days for swallowed barium to pass completely out of the gastrointestinal tract. Choices A, B, and D are incorrect because a barium swallow should be the last test performed to ensure clear imaging without interference from residual contrast material.

Correct Answer: C

Rationale: Thrombin is produced by the liver and is necessary for normal clotting. When a client with liver dysfunction has low serum levels of thrombin, they are at risk of bleeding due to impaired clotting mechanisms. Dehydration (choice A) is not directly related to low thrombin levels. Malnutrition (choice B) may impact overall health but is not the most immediate concern associated with low thrombin levels. Infection (choice D) is not directly related to the clotting function affected by low thrombin levels.

Correct Answer: C

Rationale: The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. Lying flat on the back (supine) or on the stomach (prone) after a meal can exacerbate symptoms. Similarly, lying on the right side can worsen reflux. The most appropriate position to alleviate discomfort in a client with gastroesophageal reflux disease is lying on the left side with the head of the bed elevated at a 30-degree angle. This position helps prevent the backflow of stomach contents into the esophagus, providing relief to the client.

Correct Answer: C

Rationale: To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine the hard palate of the mouth. Jaundice is best assessed in the sclera; however, in dark-skinned patients, normal yellow pigmentation may be present in the sclera, making it difficult to detect jaundice. Inspection of the hard palate for a yellow color can confirm the presence of jaundice. Cyanosis is best observed in the nail beds, not indicative of jaundice. While skin on the palm of the hand can indicate jaundice, the back of the hand is not a typical area for assessment. Jaundice can be assessed on the soles of the feet in dark-skinned patients, but it is better visualized in the hard palate for accurate evaluation.