Anna is 45 y.o. and has a bleeding ulcer. Despite multiple blood transfusions, her HGB is 7.5g/dl and HCT is 27%. Her doctor determines that surgical intervention is necessary and she undergoes partial gastrectomy. Postoperative nursing care includes:

Correct Answer: D

Rationale: In this scenario, the correct postoperative nursing care option is keeping Anna NPO until the return of peristalsis (Option D). After a partial gastrectomy for a bleeding ulcer, it is crucial to allow the gastrointestinal tract to rest and recover before reintroducing oral intake. This helps prevent complications such as aspiration, nausea, vomiting, and potential damage to the surgical site. Option A, giving pain medication Q6H, is important for managing Anna's pain postoperatively, but it is not the priority in this situation. Pain management can be adjusted based on Anna's individual needs. Option B, flushing the NG tube with sterile water, is not necessary in this case as the NG tube is typically removed once peristalsis returns and Anna can tolerate oral intake. Option C, positioning her in high Fowler's position, may be beneficial for respiratory function but is not directly related to the immediate postoperative care following a gastrectomy. Understanding the rationale behind postoperative care after gastrointestinal surgery is essential for nurses to provide safe and effective care to their patients. By prioritizing interventions based on physiological needs and surgical outcomes, nurses can help promote optimal recovery and prevent complications.

Correct Answer: A

Rationale: In Sharon's case, having cirrhosis of the liver leads to impaired liver function, causing decreased production of albumin and subsequent hypoalbuminemia. This results in a decreased colloid osmotic pressure in the blood vessels, leading to fluid shifting into the peritoneal cavity and causing ascites. Restricting fluids is the necessary intervention to decrease ascites in cirrhotic patients like Sharon. By limiting fluid intake, the body's overall fluid volume decreases, reducing the amount of fluid that accumulates in the peritoneal cavity. Encouraging ambulation is beneficial for overall health but does not directly address the underlying cause of ascites. Increasing sodium in the diet can actually worsen ascites by promoting fluid retention. Giving antacids, while important for managing other GI issues, does not address ascites specifically. Educationally, understanding the pathophysiology of ascites in cirrhosis is essential for nursing students to make appropriate clinical decisions. This knowledge helps in selecting the most effective interventions to manage complications and improve patient outcomes.

Correct Answer: A

Rationale: The correct answer is A) Give tepid baths. In the context of pruritus (itching) due to hepatitis B, tepid baths can help alleviate discomfort by soothing the skin without causing further irritation. Tepid water helps to calm the skin and reduce itching sensations, providing relief to the patient. Avoiding lotions and creams (option B) is not the best intervention as these products can sometimes exacerbate itching or cause further skin irritation in individuals with pruritus, especially in the setting of hepatitis B. Using hot water to increase vasodilation (option C) may actually worsen pruritus by further irritating the skin and increasing blood flow, which can lead to more itching and discomfort. Using cold water to decrease itching (option D) is not recommended as it can cause vasoconstriction and may not provide the same soothing effect as tepid water. In the educational context, it is important for nurses to understand the underlying causes of pruritus and how different interventions can impact patient comfort. By choosing the appropriate intervention, such as giving tepid baths in this scenario, nurses can effectively manage symptoms and improve the overall well-being of patients with hepatitis B experiencing pruritus.

Correct Answer: D

Rationale: In the case of a patient like Rob, who is suspected to have Hepatitis B and presents with jaundice and weakness, the correct intervention is option D) Rest period after small, frequent meals. This choice is appropriate because patients with Hepatitis B often experience fatigue and weakness due to the strain on their liver. Providing rest periods after meals helps to conserve energy and aids in digestion, which can be compromised in liver disease. Option A) Regular exercise is incorrect in this scenario because excessive physical activity can exacerbate fatigue and put additional stress on the liver, which is already compromised in Hepatitis B. Option B) A low-protein diet is not the best choice as protein restriction is not typically recommended for Hepatitis B patients unless there are specific complications like hepatic encephalopathy. Protein is essential for tissue repair and maintaining muscle mass, important for overall recovery. Option C) Allowing the patient to select his meals may not be ideal in this case as a patient with Hepatitis B may have dietary restrictions that need to be followed to support liver function and promote healing. Providing guidance on a suitable diet is crucial in managing the condition effectively. In a medical-surgical nursing context, understanding the specific needs of patients with liver disease such as Hepatitis B is essential. Educating patients on appropriate dietary choices, rest periods, and energy conservation strategies is crucial in promoting optimal outcomes and supporting the patient's overall well-being during their hospital stay.

Correct Answer: D

Rationale: The correct answer is option D: "My family knows that if I get tired and start vomiting, I may be getting sick again." This statement indicates patient understanding because it shows awareness of the signs and symptoms of hepatitis B recurrence, emphasizing the importance of monitoring for early indications of illness. This reflects a proactive approach to managing the condition and seeking timely medical intervention if needed. Option A is incorrect because having had hepatitis B previously does not confer immunity from future infections or reinfections. Option B is incorrect as individuals with hepatitis B are typically deferred from donating blood due to the risk of transmitting the virus. Option C is also incorrect as ongoing liver damage can occur from alcohol consumption, especially in the context of hepatitis B. From an educational perspective, this question assesses the patient's understanding of hepatitis B management and self-care measures post-discharge. It highlights the importance of patient education in promoting self-awareness, early recognition of symptoms, and adherence to follow-up care to prevent disease progression and complications.