Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?

Correct Answer: C

Rationale: Coffee-ground emesis is a sign of upper gastrointestinal bleeding that occurred approximately 2 hours earlier. It results from the breakdown of blood in the stomach due to digestive enzymes, giving it a coffee-ground appearance. Choice A is incorrect because coffee-ground emesis indicates older, partially digested blood, not fresh active bleeding. Choice B is incorrect as gastric lavage is not indicated for coffee-ground emesis. Choice D is incorrect because a transfusion of packed RBCs is not the immediate management for this presentation.

Correct Answer: D

Rationale: In the context of a patient with a retractable gastric peptic ulcer who has undergone a gastric vagotomy, it is crucial to understand the effects of this surgical procedure on various factors within the gastrointestinal system. In this scenario, the correct answer is D) Gastric pH increases as a result of vagotomy. A gastric vagotomy involves cutting the vagus nerve, which plays a significant role in stimulating gastric acid secretion. Without this neural input, the production of gastric acid is reduced, leading to an increase in gastric pH. This change in pH can have implications for the patient's overall digestive process and ulcer healing. Now let's analyze why the other options are incorrect: A) Peristalsis: Vagotomy does not have a direct effect on peristalsis, which is the involuntary contraction and relaxation of muscles in the GI tract to move food along the digestive system. B) Gastric acidity: Vagotomy actually decreases gastric acidity due to the reduction in acid secretion. C) Gastric motility: While vagotomy can affect gastric motility to some extent, it does not directly increase gastric motility. The impact on motility is more complex and not as straightforward as the effect on pH. Understanding the effects of gastric vagotomy on gastric pH is essential for nurses caring for patients who have undergone this procedure. It influences the management of conditions such as peptic ulcers and requires close monitoring and appropriate interventions to support the patient's recovery and overall gastrointestinal health.

Correct Answer: A

Rationale: In this question, the correct answer is A) 60 ml. To understand why this is the right choice, we need to consider the given concentration of the supplement, which is 80 ml of supplement mixed with 20 ml of water. The total mixture is 100 ml. When we are asked how much water to mix with an 8 oz (240 ml) can of feeding, we need to maintain the same concentration ratio. To calculate the amount of water needed, we use the ratio of supplement to water, which is 80 ml to 20 ml. If we consider 240 ml of feeding as the total (100%), we can set up a proportion where x (amount of water needed) is to 240 ml as 20 ml is to 100 ml. Solving this proportion, we find that x = (20 * 240) / 100 = 48 ml. However, since we already have 20 ml of water in the 8 oz can, we only need to add 60 ml more to reach the 80 ml total required for the correct concentration. Now, let's evaluate why the other options are incorrect: B) 70 ml: This amount does not maintain the correct concentration ratio of 80 ml supplement to 20 ml water. C) 80 ml: This option suggests adding the same amount of water as the supplement, which would disrupt the correct concentration ratio needed for the enteral feeding. D) 90 ml: Adding 90 ml of water would dilute the supplement beyond the required concentration, making it incorrect for the enteral feeding. Educationally, understanding how to calculate and maintain proper concentrations for enteral feedings is crucial in medical-surgical nursing. It ensures that patients receive the appropriate nutrients and medications in the right proportions to support their health and recovery. Mastering these calculations is essential for providing safe and effective care to patients requiring enteral nutrition.

Correct Answer: A

Rationale: In this case, the correct answer is A) Ileostomy. An ileostomy typically produces malodorous, enzyme-rich, caustic liquid output that can be yellow, green, or brown in color. This is due to the fact that an ileostomy is created from the small intestine, where digestive enzymes are still present, leading to the characteristic output described. The incorrect options include B) Ascending colostomy, C) Transverse colostomy, and D) Descending colostomy. These types of colostomies are created from the large intestine (colon) where the stool is more formed and less liquid compared to the small intestine. Therefore, they would not produce the same type of malodorous, enzyme-rich, liquid output as an ileostomy. In the context of medical surgical nursing, understanding the different types of stomas and their expected outputs is crucial for providing optimal care to patients with ostomies. Recognizing the characteristics of each type of stoma helps nurses in assessing and managing complications, providing appropriate patient education, and promoting patient comfort and quality of life.

Correct Answer: B

Rationale: The correct answer is B: "The drainage will decrease daily until the bile duct heals." Rationale: This information is crucial for George to understand as it prepares him for what to expect post-surgery. After gallbladder surgery with a T tube in place, the drainage from the tube will gradually decrease as the bile duct heals. This education empowers the patient to monitor his recovery progress and alleviates unnecessary anxiety about the drainage. Option A: "If there is any drainage, notify the surgeon immediately." While it is important to monitor drainage, not all drainage warrants immediate notification. This option could cause unnecessary alarm for the patient. Option C: "First, the drainage is dark green; then it becomes dark yellow." This information, although descriptive, does not provide actionable guidance for the patient in managing the T tube drainage. Option D: "If the drainage stops, milk the tube toward the puncture wound." This instruction is incorrect as milking the tube can lead to complications such as dislodging the tube or causing injury to the bile duct. In an educational context, it is essential for nurses to provide clear, accurate, and relevant information to patients regarding postoperative care, including the management of drainage tubes. Understanding the rationale behind postoperative instructions empowers patients to participate actively in their recovery process and promotes a smooth transition from the hospital to home care.