After a subtotal gastrectomy, care of the client's nasogastric tube and drainage system should include which of the following nursing interventions?

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 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.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) The ulcer has perforated. When a client with a bleeding duodenal ulcer presents with sudden, sharp pain in the midepigastric area and a rigid, boardlike abdomen, it suggests a serious complication like perforation of the ulcer. Perforation leads to the leaking of gastric contents into the peritoneal cavity, causing severe pain and abdominal rigidity. Option A) An intestinal obstruction is incorrect because the symptoms described do not align with those of an obstruction. Option B) Additional ulcers developing is unlikely to cause the sudden, sharp pain and rigidity described. Option C) Inflammation of the esophagus does not typically present with a rigid, boardlike abdomen and sudden, severe pain. In the context of medical-surgical nursing, understanding the complications of gastrointestinal disorders is crucial for timely intervention and preventing further deterioration. Recognizing the signs of a perforated ulcer is essential for nurses to promptly alert healthcare providers for appropriate management, which may include surgical intervention. This knowledge ensures optimal patient outcomes and highlights the importance of thorough assessment and clinical reasoning in nursing practice.

Correct Answer: D

Rationale: In understanding why a hiatal hernia can be caused by weakness of the diaphragmatic muscle (Option D), it is essential to have a grasp of the anatomical structures involved. The esophagus passes through an opening in the diaphragm called the esophageal hiatus. When there is weakness in the diaphragmatic muscle, particularly around this opening, part of the stomach can protrude through the diaphragm into the chest cavity, resulting in a hiatal hernia. Option A, increased intrathoracic pressure, is not a direct cause of a hiatal hernia. While increased pressure in the abdomen can contribute to the development of a hiatal hernia, it is not the primary cause. Option B, weakness of the esophageal muscle, is not a common cause of a hiatal hernia. The primary issue in a hiatal hernia lies in the weakening of the diaphragmatic muscle rather than the esophageal muscle. Option C, increased esophageal muscle pressure, is not a typical cause of a hiatal hernia. In fact, increased pressure within the esophagus can be a result of the hernia rather than the cause. Understanding the pathophysiology of conditions such as hiatal hernia is crucial for nursing practice, especially in medical-surgical settings. Nurses need to be able to recognize the risk factors, signs, and symptoms of hiatal hernias to provide appropriate care and education to patients. By grasping the underlying causes, nurses can better explain the condition to patients and assist in developing effective care plans.